Cryosurgery in the excision of a giant local recurrent sacral chordoma: a case report and literature review



Chordoma is a low-grade malignant tumor with recurrence and metastasis tendency that originates from embryonic notochordal remnants. The sacrococcygeal region is the most commonly involved site. The aim of this paper is to report the results of the use of cryosurgery in the excision of a giant recurrent sacral chordoma and review of pertinent literature.


A 64 years old female patient with a locally recurrent sacral chordoma came to our attention after ten interventions performed at another institute. A surgical treatment was performed using argon cryosurgery.


In this case, it was not possible to perform a marginal or wide excision, but it was intralesional with the removal of three major blocks. The fragments sent for the histological analysis measured total 35 × 30 × 8 cm with a weight of 4.260 g.


Given the gelatinous structure of the tumor and the possibility of contamination of operatory field, cryosurgery may be indicated when previous surgeries and the dimensions of tumor mass do not allow a resection with negative margins improving radiotherapy efficacy in the local control of tumor.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. 1.

    McMaster ML, Goldstein AM, Bromley CM et al (2001) Chordoma: incidence and survival patterns in the United States, 1973–1995. Cancer Causes Control 12:1–11

    CAS  Article  Google Scholar 

  2. 2.

    Ropper AE, Cahill KS, Hanna JW et al (2012) Primary vertebral tumors: a review of epidemiologic, histological and imaging findings, part II: locally aggressive and malignant tumors. Neurosurgery 70:211–219

    Article  Google Scholar 

  3. 3.

    Sciubba DM, Chi JH, Rhines LD et al (2008) Chordoma of the spinal column. Neurosurg Clin N Am 19:5–15

    Article  Google Scholar 

  4. 4.

    Hsieh PC, Xu R, Sciubba DM, McGirt MJ, Nelson C, Witham TF et al (2009) Long-term clinical outcomes following en bloc resections for sacral chordomas and chondrosarcomas: a series of twenty consecutive patients. Spine (Phila Pa 1976) 34(20):2233–2239

    Article  Google Scholar 

  5. 5.

    Yang Y, Niu X, Li Y, Liu W, Xu H (2017) Recurrence and survival factors analysis of 171 cases of sacral chordoma in a single institute. Eur Spine J 7:1910–1916

    Article  Google Scholar 

  6. 6.

    York JE, Kaczaraj A, Abi-Said D, Fuller GN, Skibber JM, Janjan NA, Gokaslan ZL (1999) Sacral chordoma: 40-year experience at a major cancer center. Neurosurgery 44(1):74–79 (discussion 79–80)

    CAS  Article  Google Scholar 

  7. 7.

    Samson IR, Springfield DS, Suit HD (1993) Operative treatment of sacrococcygeal chordoma. J Bone Joint Surg (Am) 75(10):1476–1484

    CAS  Article  Google Scholar 

  8. 8.

    Baratti D, Gronchi A, Pennacchioli E et al (2003) Chordoma: natural history and results in 28 patients treated at a single institution. Ann Surg Oncol 10:291–296

    CAS  Article  Google Scholar 

  9. 9.

    Bergh P, Kindblom LG, Gunterberg B et al (2000) Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients. Cancer 88:2122–2134

    CAS  Article  Google Scholar 

  10. 10.

    Fuchs B, Dickey ID, Yaszemski MJ et al (2005) Operative management of sacral chordoma. J Bone Joint Surg Am 87:2211–2216

    PubMed  Google Scholar 

  11. 11.

    Gunterberg B, Romanus B, Sterner B (1976) Pelvic strength after major amputation of the sacrum. An experimental study. Acta Orthop Scand 47:635–642

    CAS  Article  Google Scholar 

  12. 12.

    Hulen CA, Temple HT, Fox WP et al (2006) Oncologic and functional outcome following sacrectomy for sacral chordoma. J Bone Joint Surg Am 88:1532–1539

    Article  Google Scholar 

  13. 13.

    Osaka S, Kodoh O, Sugita H et al (2006) Clinical significance of a wide excision policy for sacrococcygeal chordoma. J Cancer Res Clin Oncol 132:213–218

    Article  Google Scholar 

  14. 14.

    Yonemoto T, Tatezaki S, Takenouchi T et al (1999) The surgical management of sacrococcygeal chordoma. Cancer 85:878–883

    CAS  Article  Google Scholar 

  15. 15.

    Chen KW, Yang HL, Lu J et al (2010) Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients. Spinal Cord 48:166–171

    CAS  Article  Google Scholar 

  16. 16.

    Hanna A, Aston S, Briggs R et al (2008) Sacral chordoma can local recurrence after sacrectomy be predicted? Clin Orthop Relat Res 466:2217–2223

    CAS  Article  Google Scholar 

  17. 17.

    Ailon T, Torabi R, Fisher CG, Rhines LD, Clarke MJ, Bettegowda C, Boriani S, Yamada YJ, Kawahara N, Varga PP, Shin JH, Saghal A, Gokaslan ZL (2016) Management of locally recurrent chordoma of the mobile spine and sacrum. A systematic review. Spine 41(20S):S193–S198

    Article  Google Scholar 

  18. 18.

    Zoccali C, Skoch J, Patel AS, Walter CM, Maykowski P, Baaj AA (2016) Residual neurological function after sacral root resection during en-bloc sacrectomy: a systematic review. Eur Spine J 25:3925–3931

    Article  Google Scholar 

  19. 19.

    Cahan WG (1964) Criosurgery of the uterus: description of technique and potential application. Am J Obstet Gynecol 88:410–414

    CAS  Article  Google Scholar 

  20. 20.

    Cahan WG (1965) Cryosurgery of malignant and benign tumors. Fed Proc 24:S241–S248

    CAS  PubMed  Google Scholar 

  21. 21.

    Marcove RC, Miller TR, Cahan WC (1968) The treatment of primary and metastatic bone tumors by repetitive freezing. Bull N Y Acad Med 44:532–544

    CAS  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Marcove RC (1982) A 17-year review of cryosurgery in the treatment of bone tumors. Clin Orthop 163:231–234

    Google Scholar 

  23. 23.

    De Vries J, Oldhoff J, Hadders HN (1989) Cryosurgical treatment of sacrococcygeal chordoma. Report of four cases. Cancer 58(10):2348–2354

    Article  Google Scholar 

  24. 24.

    Schwab JH, Healey JH, Rose P, Casas-Ganem J, Boland PJ (2009) The surgical management of sacral chordomas. Spine (Phila Pa 1976) 34(24):2700–2704.

    Article  Google Scholar 

  25. 25.

    Kurup AN, Woodrum DA, Morris JM, Atwell TD, Schmit GD, Welch TJ, Yaszemski MJ, Callstrom MR (2012) Cryoablation of recurrent sacrococcygeal tumors. J Vasc Interv Radiol 23(8):1070–1075

    Article  Google Scholar 

  26. 26.

    Stacchiotti S et al (2017) Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group. Ann Oncol 28:1230–1242

    CAS  Article  Google Scholar 

Download references


The authors thank Carlo Piovani and Cristiana Griffoni for their helpful collaboration in imaging storage and data management.


No funds were received in support of this study.

Author information



Corresponding author

Correspondence to Valerio Pipola.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Pipola, V., Girolami, M., Ghermandi, R. et al. Cryosurgery in the excision of a giant local recurrent sacral chordoma: a case report and literature review. Eur Spine J 27, 3059–3063 (2018).

Download citation


  • Local recurrent chordoma
  • Sacral chordoma
  • Cryosurgery
  • Cryotherapy