Dural Reconstruction with a Vascularized Pleural Flap following en Bloc Resection of a Thoracic Epithelioid Sarcoma: Technical Note

Abstract BACKGROUND AND IMPORTANCE Occurrence of spinal epithelioid sarcomas is rare, with few cases reported in the literature. Although wide local resection is the recommended treatment, this technique is challenging in the spine. CLINICAL PRESENTATION The case of a 17-year-old male with a recurrent epithelioid sarcoma with intradural extension in the cervical spine is presented. Because of nerve root involvement, the patient presented with right upper extremity weakness. The patient underwent a posterior C1-C4 spondylectomy to achieve an en bloc resection, followed by reconstruction from the occiput to T4. The right vertebral artery and C1-C4 nerve roots were sacrificed because of tumor involvement. After 3 years of follow-up the patient is disease-free but has persistent right deltoid weakness. CONCLUSION Cervical spondylectomy via a single-staged posterior approach is a challenging yet feasible procedure for the treatment of epithelioid sarcomas. To the best of the authors' knowledge, this is the first report of complete resection of an epithelioid sarcoma with intradural extension in the cervical spine. Although neurovascular structures may warrant sacrifice, this procedure may provide improved long-term prognosis.

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Combined posterior hemiosteotomies and stabilization with lateral thoracotomy for en bloc resection of thoracic paraspinal primary bone tumors: technical note

Journal of Neurosurgery Spine ◽

10.3171/2015.4.spine15107 ◽

2016 ◽

Vol 24 (2) ◽

pp. 223-227 ◽

Cited By ~ 1

Author(s):

Mauricio J. Avila ◽

Jesse Skoch ◽

Vernard S. Fennell ◽

Sheri K. Palejwala ◽

Christina M. Walter ◽

...

Keyword(s):

Bone Tumors ◽

En Bloc Resection ◽

Bloc Resection ◽

Technical Note ◽

En Bloc ◽

Primary Bone Tumors ◽

Primary Bone ◽

En Bloc Excision ◽

Bloc Excision ◽

Lateral Thoracotomy

Primary bone tumors of the spine are rare entities with a poor prognosis if left untreated. En bloc excision is the preferred surgical approach to minimize the rate of recurrence. Paraspinal primary bone tumors are even less common. In this technical note the authors present an approach to the en bloc resection of primary bone tumors of the paraspinal thoracic region with posterior vertebral body hemiosteotomies and lateral thoracotomy. They also describe 2 illustrative cases.

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Clamshell thoracotomy for en bloc resection of a 3-level thoracic chordoma: technical note and operative video

Neurosurgical FOCUS ◽

10.3171/2020.6.focus20382 ◽

2020 ◽

Vol 49 (3) ◽

pp. E16

Author(s):

John F. Burke ◽

Andrew K. Chan ◽

Rory R. Mayer ◽

Joseph H. Garcia ◽

Brenton Pennicooke ◽

...

Keyword(s):

Tumor Resection ◽

Posterior Spinal Fusion ◽

En Bloc Resection ◽

Bloc Resection ◽

Technical Note ◽

Spinal Tumors ◽

En Bloc ◽

Clamshell Thoracotomy ◽

Bloc Excision ◽

Upper Thoracic

The clamshell thoracotomy is often used to access both hemithoraxes and the mediastinum simultaneously for cardiothoracic pathology, but this technique is rarely used for the excision of spinal tumors. We describe the use of a clamshell thoracotomy for en bloc excision of a 3-level upper thoracic chordoma in a 20-year-old patient. The lesion involved T2, T3, and T4, and it invaded both chest cavities and indented the mediastinum. After 2 biopsies to confirm the diagnosis, the patient underwent a posterior spinal fusion followed by bilateral clamshell thoracotomy for 3-level en bloc resection with simultaneous access to both chest cavities and the mediastinum. To demonstrate how the clamshell thoracotomy was used to facilitate the tumor resection, an operative video and illustrations are provided, which show in detail how the clamshell thoracotomy can be used to access both hemithoraxes and the mediastinum.

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