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Surgical workflow for fully navigated high sacral amputation in sacral chordoma

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Abstract

The method of choice for treatment of sacral chordomas is en bloc tumor removal via sacrectomy or sacral amputation in varying degrees depending on the initial tumor extent. Besides local tumor control, the preservation of neurological function is equally important to minimize postoperative bladder and bowel dysfunction. Removal of sacral tumors is complicated by the complex regional anatomy of the pelvis and the surrounding visceral and retroperitoneal structures. We aim to describe the surgical workflow for a fully navigated high sacral amputation facilitated by integration of an intraoperative computed tomography (iCT)-based spinal navigation system. An iCT-based spinal navigation system (AIRO® CT scanner, Brainlab AG, Feldkirchen, Germany) was used to perform intraoperative navigation with an image-guidance system and infrared tracking camera (BrainLab CurveTM, Brainlab AG, Feldkirchen, Germany) in combination with the spinal navigation set by Brainlab (Brainlab AG, Feldkirchen, Germany) to perform a fully navigated high sacral amputation. We demonstrate the successful implementation of iCT-based spinal navigation during high sacral amputation and the key advantages of this technique throughout the surgery. iCT-based spinal navigation is a useful complementing technique for en bloc high sacral amputations that renders the surgery safer and more accurate.

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Funding

This study was funded by the Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany.

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Authors and Affiliations

  1. Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Johannes Goldberg, Simon Heinrich Bayerl & Peter Vajkoczy

  2. Division of Plastic and Reconstructive Surgery, Department of Surgery, Campus Charité Mitte–Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Christian Witzel

  3. Department of Surgery, Campus Charité Mitte–Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Felix Aigner

  4. Department of Neurosurgery, University of California, 400 Parnassus Ave, San Francisco, CA, 94122, USA

    Christopher P. Ames

Authors
  1. Johannes Goldberg
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  2. Simon Heinrich Bayerl
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  3. Christian Witzel
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  4. Felix Aigner
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  6. Peter Vajkoczy
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Correspondence to Peter Vajkoczy.

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Goldberg, J., Bayerl, S.H., Witzel, C. et al. Surgical workflow for fully navigated high sacral amputation in sacral chordoma. Neurosurg Rev 43, 343–349 (2020). https://doi.org/10.1007/s10143-019-01194-1

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  • DOI: https://doi.org/10.1007/s10143-019-01194-1

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