Abstract
Sacral tumors are amongst the most challenging procedures to treat because of the complex anatomy. This study determined whether patient-specific models change preoperative planning decisions made in preparation for en bloc resection of complex sacral mass surgical procedures. Imaging showed a big encapsulated mass at the S2–3 level involving the neural foramina and obscuring the nerve roots. High-resolution images were acquired and utilized to generate a patient-specific 3D tumor model. The visual and tactile inspection of 3D models allowed the best anatomical understanding, with faster and clearer comprehension of the surgical anatomy. The 3D sacral model was for observation of previously unapparent anatomical details; with this new technology, surgeon can observe their planned surgical intervention, explore the patient-specific anatomy and extension of the tumor, and sharpen their procedure choices. Moreover, multiple planes showed how far the angles on the plane would extend for osteotomy of the sacrum. Another result was identifying correct guides and safe venture landmarks. The study helped to establish safe osteotomy line wherever the nerve roots were retained and enabled osteotomy by preserving bilaterally the S1 and S2 nerve roots for wide excision of wide excision of primary sacral tumor to get adequate bowel and bladder functions. Finally, it helped to determine whether or not the remaining bone in the sacrum is sufficient for spinopelvic stability and needed fixation. It was decided spinopelvic fixation was not necessary for this case. Surgical intervention of sacral tumors varies depending on the tumor, its size, extension, and location. Surgery can have profound risks including unnecessary nerve root resection spinopelvic instability and suboptimal oncological resection. 3D models help to transfer complex anatomical information to clinicians and provide guidance in the preoperative planning stage, for intraoperative navigation and for surgical training purposes.
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References
Staats K, Panotopoulos J, Tiefenboeck TM, Windhager R, Funovics PT (2017) Computer navigation-assisted surgery for musculoskeletal tumors: a closer look into the learning curve. Eur J Orthop Surg Traumatol 27:851–858
Thomas M, Davies AM, Stirling AJ, Grimer RJ, Grainger M, James SL (2014) Imaging appearances and clinical outcome following sacrectomy and ilio-lumbar reconstruction for sacral neoplasia. Skelet Radiol 43:179–189
Arikan M, Togral G, Hasturk AE, Aktas E, Gungor S (2014) Management and retrospective analysis of primary and metastatic sacral tumors and infections: evaluation with 73 cases. Eklem Hastalik Cerrahisi 25:126–132
Hsieh PC, Xu R, Sciubba DM, McGirt MJ, Nelson C, Witham TF, Wolinksy JP, Gokaslan ZL (2009) Long-term clinical outcomes following en bloc resections for sacral chordomas and chondrosarcomas: a series of twenty consecutive patients. Spine (Phila Pa 1976) 34:2233–2239
Nishizawa K, Mori K, Saruhashi Y, Takahashi S, Matsusue Y (2014) Long-term clinical outcome of sacral chondrosarcoma treated by total en bloc sacrectomy and reconstruction of lumbosacral and pelvic ring using intraoperative extracorporeal irradiated autologous tumor-bearing sacrum: a case report with 10 years follow-up. Spine J 14:e1–e8
Puri A, Agarwal MG, Shah M, Srinivas CH, Shukla PJ, Shrikhande SV, Jambhekar NA (2009) Decision making in primary sacral tumors. Spine J 9:396–403
Possover M, Uehlinger K, Ulrich Exner G (2014) Laparoscopic assisted resection of a ilio-sacral chondrosarcoma: a single case report. Int J Surg Case Rep 5:381–384
Minasian T, Claus C, Hariri OR, Piao Z, Quadri SA, Yuhan R, Leong D, Tashjian V (2016) Chondromyxoid fibroma of the sacrum: a case report and literature review. Surg Neurol Int 7(Suppl 13):S370–S374
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
van Wulfften Palthe OD, Houdek MT, Rose PS, Yaszemski MJ, Sim FH, Boland PJ, Healey JH, Hornicek FJ, Schwab JH (2017) How does the level of nerve root resection in en bloc sacrectomy influence patient-reported outcomes? Clin Orthop Relat Res 475:607–616
Li D, Guo W, Tang X, Yang R, Tang S, Qu H, Yang Y, Sun X, Du Z (2014) Preservation of the contralateral sacral nerves during hemisacrectomy for sacral malignancies. Eur Spine J 23:1933–1999
Clarke MJ, Zadnik PL, Groves ML, Dasenbrock HH, Sciubba DM, Hsu W, Witham TF, Bydon A, Gokaslan ZL, Wolinsky JP (2014) En bloc hemisacrectomy and internal hemipelvectomy via the posterior approach. J Neurosurg Spine 21:458–467
Mendel E, Mayerson JL, Nathoo N, Edgar RL, Schmidt C, Miller MJ (2011) Reconstruction of the pelvis and lumbar-pelvic junction using 2 vascularized autologous bone grafts after en bloc resection for an iliosacral chondrosarcoma. J Neurosurg Spine 15:168–173
Newman CB, Keshavarzi S, Aryan HE (2009) En bloc sacrectomy and reconstruction: technique modification for pelvic fixation. Surg Neurol 72:752–756
Gillis CC, Street JT, Boyd MC, Fisher CG (2014) Pelvic reconstruction after subtotal sacrectomy for sacral chondrosarcoma using cadaveric and vascularized fibula autograft: Technical note. J Neurosurg Spine 21:623–627
Mendel E, Nathoo N, Scharschmidt T, Schmidt C, Boehmler J, Mayerson JL (2014) Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension: technical note. J Neurosurg Spine 20:327–334
Kim D, Lim JY, Shim KW, Han JW, Yi S, Yoon DH, Kim KN, Ha Y, Ji GY, Shin DA (2017) Sacral reconstruction with a 3D-printed implant after hemisacrectomy in a patient with sacral osteosarcoma: 1-year follow-up result. Yonsei Med J 58:453–457
Drazin D, Bhamb N, Al-K houja LT, Kappel AD, Kim TT, Johnson JP, Brien E (2017) Image-guided resection of aggressive sacral tumors. Neurosurg Focus 42:E15
Schoenfeld AJ, Hornicek FJ, Pedlow FX, Kobayashi W, Raskin KA, Springfield D, DeLaney TF, Nielsen GP, Mankin HJ, Schwab JH (2012) Chondrosarcoma of the mobile spine: a review of 21 cases treated at a single center. Spine (Phila Pa 1976) 37:119–126
Govsa F, Yagdi T, Ozer MA, Eraslan C, Alagoz AK (2017) Building 3D anatomical model of coiling of the internal carotid artery derived from CT angiographic data. Eur Arch Otorhinolaryngol 274:1097–1102
Govsa F, Karakas AB, Ozer MA, Eraslan C (2018) Development of life-size patient-specific 3D-printed dural venous models for preoperative planning. World Neurosurg 110:e141–e149
Govsa F, Ozer MA, Biceroglu H, Karakas AB, Cagli S, Eraslan C, Alagoz AK (2018) Creation of 3-dimensional life size: patient-specific C1 fracture models for screw fixation. World Neurosurg 114:e579–e585
Andolfi C, Plana A, Kania P, Banerjee PP, Small S (2017) Usefulness of three-dimensional modeling in surgical planning, resident training, and patient education. J Laparoendosc Adv Surg Tech A 27:512–515
Cromeens BP, Ray WC, Hoehne B, Abayneh F, Adler B, Besner GE (2017) Facilitating surgeon understanding of complex anatomy using a three-dimensional printed model. J Surg Res 216:18–25
Zheng YX, Yu DF, Zhao JG, Wu YL, Zheng B (2016) 3D printout models and 3D rendered images: which is better for preoperative planning? J Surg Educ 73:518–523
Yang T, Lin S, Tan T, Yang J, Pan J, Hu C, Li J, Zou Y (2018) Impact of 3D printing technology on comprehension of surgical anatomy of retroperitoneal tumor. World J Surg 42:2339–2343
Perica E, Sun Z (2017) Patient-specific three-dimensional printing for pre-surgical planning in hepatocellular carcinoma treatment. Quant Imaging Med Surg 7:668–677
Wake N, Rude T, Kang SK, Stifelman MD, Borin JF, Sodickson DK, Huang WC, Chandarana H (2017) 3D printed renal cancer models derived from MRI data: application in pre-surgical planning. Abdom Radiol (NY) 42:1501–1509
Komai Y, Sugimoto M, Gotohda N, Matsubara N, Kobayashi T, Sakai Y, Shiga Y, Saito N (2016) Patient-specific 3-dimensional printed kidney designed for “4D” surgical navigation: a novel aid to facilitate minimally invasive off-clamp partial nephrectomy in complex tumor cases. Urology 91:226–233
Soon DS, Chae MP, Pilgrim CH, Rozen WM, Spychal RT, Hunter-Smith DJ (2016) 3D haptic modelling for preoperative planning of hepatic resection: a systematic review. Ann Med Surg (Lond) 10:1–7
Phukan R, Herzog T, Boland PJ, Healey J, Rose P, Sim FH, Yazsemski M, Hess K, Osler P, DeLaney TF, Chen YL, Hornicek F, Schwab J (2016) How does the level of sacral resection for primary malignant bone tumors affect physical and mental health, pain, mobility, incontinence, and sexual function? Clin Orthop Relat Res 474:687–696
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Ozturk, A.M., Ozer, M.A., Suer, O. et al. Patient-Specific Three-Dimensional Model for a Safe Surgical Pathway in Sacral Chondrosarcoma. Indian J Surg Oncol 10, 107–114 (2019). https://doi.org/10.1007/s13193-018-0851-6
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DOI: https://doi.org/10.1007/s13193-018-0851-6