Surgical Resection of Calvarial Metastases Overlying Dural Sinuses

Neurosurgery ◽  
2001 ◽  
Vol 48 (4) ◽  
pp. 745-755 ◽  
Author(s):  
Christopher B. Michael ◽  
Ziya L. Gokaslan ◽  
Franco DeMonte ◽  
Ian E. McCutcheon ◽  
Raymond Sawaya ◽  
...  
Keyword(s):  
Blood Loss ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Venous Sinus ◽  
Neurological Deficits ◽  
Dural Sinus ◽  
En Bloc ◽  
Primary Tumors ◽  
Venous Sinuses ◽  
Piecemeal Resection

Abstract OBJECTIVE Few reports have addressed the surgical management of cranial metastases that overlie or invade the dural venous sinuses. To examine the role of surgery in the treatment of dural sinus calvarial metastases, we reviewed retrospectively 13 patients who were treated with surgery at the University of Texas M.D. Anderson Cancer Center between 1993 and 1999. We compared them with 14 patients who had calvarial metastases that did not involve a venous sinus. METHODS Clinical charts, radiological studies, pathological findings, and operative reports were analyzed retrospectively. RESULTS The median age of patients with dural sinus calvarial metastases was 54 years. Nine patients were men and four were women. Renal cell carcinoma and sarcoma were the most common primary tumors. Similar features were noted in the 14 patients with nonsinus calvarial metastases. Of the 13 dural sinus calvarial metastases, 11 involved the superior sagittal sinus, and 2 involved the transverse sinus. In nine patients, the involved sinus was resected, and in four patients, the sinus was reconstituted after tumor removal. Nine patients in the dural sinus calvarial metastases group received en bloc resection, and four received piecemeal resection. No operative deaths occurred. The overall median actuarial survival was 16.5 months. The survival times of the two groups were comparable. In the group with dural sinus calvarial metastases, transient postoperative neurological deficits occurred in two patients (15%), and a permanent deficit occurred in one patient (8%). No patients in the group with nonsinus calvarial metastases experienced deficits after resection. Compared with piecemeal resection, en bloc resection was associated with significantly less blood loss. CONCLUSION Complete extirpation of calvarial metastases that overlie or invade a dural sinus can be achieved with only slightly more morbidity than complete removal of calvarial metastases that are located away from the sinuses. En bloc resection is as safe as piecemeal resection and is more effective in limiting operative blood loss. The overall recurrence and survival rates of patients with dural sinus calvarial metastases are similar to those of patients with calvarial metastases that do not involve the sinuses. Therefore, involvement of a dural venous sinus should not discourage resection of calvarial metastases. In carefully selected cancer patients, surgery provides effective palliation of symptomatic calvarial metastases that overlie or invade the venous sinuses.

scholarly journals Endoscopic resection outcomes and predictors of failed en bloc endoscopic mucosal resection of colorectal polyps ≤ 20 mm among advanced endoscopy trainees

2021 ◽  
Vol 09 (11) ◽  
pp. E1820-E1826
Author(s):  
William W. King ◽  
Peter V. Draganov ◽  
Andrew Y. Wang ◽  
Dushant Uppal ◽  
Amir Rumman ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Endoscopic Mucosal Resection ◽  
En Bloc Resection ◽  
Lesion Size ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
Polyp Size ◽  
En Bloc ◽  
Mucosal Resection ◽  
Piecemeal Resection

Abstract Background and study aims En bloc endoscopic mucosal resection (EMR) is preferred over piecemeal resection for polyps ≤ 20 mm. Data on colorectal EMR training are limited. We aimed to evaluate the en bloc EMR rate of polyps ≤ 20 mm among advanced endoscopy trainees and to identify predictors of failed en bloc EMR. Methods This was a multicenter prospective study evaluating trainee performance in EMR during advanced endoscopy fellowship. A logistic regression model was used to identify the number of procedures and lesion cut-off size associated with an en bloc EMR rate of ≥ 80 %. Multivariate analysis was performed to identify predictors of failed en bloc EMR. Results Six trainees from six centers performed 189 colorectal EMRs, of which 104 (55 %) were for polyps ≤ 20 mm. Of these, 57.7 % (60/104) were resected en bloc. Trainees with ≥ 30 EMRs (OR 6.80; 95 % CI: 2.80–16.50; P = 0.00001) and lesions ≤ 17 mm (OR 4.56;95 CI:1.23–16.88; P = 0.02) were more likely to be associated with an en bloc EMR rate of ≥ 80 %. Independent predictors of failed en bloc EMR on multivariate analysis included: larger polyp size (OR:6.83;95 % CI:2.55–18.4; P = 0.0001), right colon location (OR:7.15; 95 % CI:1.31–38.9; P = 0.02), increased procedural difficulty (OR 2.99; 95 % CI:1.13–7.91; P = 0.03), and having performed < 30 EMRs (OR: 4.87; 95 %CI: 1.05–22.61; P = 0.04). Conclusions In this pilot study, we demonstrated that a relatively low proportion of trainees achieved en bloc EMR for polyps ≤ 20 mm and identified procedure volume and lesion size thresholds for successful en bloc EMR and independent predictors for failed en bloc resection. These preliminary results support the need for future efforts to define EMR procedure competence thresholds during training.

Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumor metastasis to the posterior fossa

2008 ◽  
Vol 108 (2) ◽  
pp. 248-257 ◽  
Author(s):  
Dima Suki ◽  
Hiba Abouassi ◽  
Akash J. Patel ◽  
Raymond Sawaya ◽  
Jeffrey S. Weinberg ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Posterior Fossa ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Primary Study ◽  
Leptomeningeal Disease ◽  
En Bloc ◽  
Resection Group ◽  
Significant Difference ◽  
Piecemeal Resection

Object The authors tested the hypothesis that patients with metastatic posterior fossa lesions (MPFLs) treated with resection have a higher risk of leptomeningeal disease (LMD) than those with MPFLs treated with stereotactic radiosurgery (SRS). Methods Between 1993 and 2004, 379 patients with MPFLs were treated with resection or SRS at The University of Texas M. D. Anderson Cancer Center. The authors' primary study outcome was the incidence of LMD, as diagnosed with cerebrospinal fluid cytological analysis and/or neuroimaging. Results Resection was performed in 260 patients, whereas 119 patients underwent SRS. The median patient age was 56 years, 51% of patients were male, and 93% had a Karnofsky Performance Scale score $ 70. The most common primary cancers were those of the lung, breast, and kidney, as well as melanoma. Leptomeningeal dissemination of cancer occurred in 33 patients: 26 in the resection group and 7 in the SRS group (resection group: rate ratio [RR] 2.06, 95% confidence interval [CI] 0.89–4.75, p = 0.09). Piecemeal tumor resection (137 cases) was associated with a significantly higher risk of LMD than en bloc resection (123 cases; RR 3.4, 95% CI 1.43–8.12, p = 0.006) or SRS (RR 3.37, 95% CI 1.41–8.04, p = 0.006), and there was no significant difference in the risk for LMD between en bloc resection and SRS (en bloc resection: RR 0.98, 95% CI 0.34–2.81, p = 0.98). The multivariate RR and significance associated with piecemeal resection, however, were consistent, with a strong effect (RR 2.45, 95% CI 1.19–5.02, p = 0.02) and no indication of biases associated with tumor size, location, or cystic/necrotic appearance. Conclusions There is an increased risk of LMD after piecemeal resection of an MPFL. This increase, although clinically and statistically significant, is not as alarming as previously reported and is absent when en bloc removal is achieved. Further assessment of the role of resection in a controlled prospective setting is warranted.

scholarly journals High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors

2015 ◽  
Vol 23 (6) ◽  
pp. 788-797 ◽  
Author(s):  
Ronny L. Rotondo ◽  
Wendy Folkert ◽  
Norbert J. Liebsch ◽  
Yen-Lin E. Chen ◽  
Frank X. Pedlow ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Prognostic Factors ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Tumor Control ◽  
High Dose ◽  
Recurrence Rates ◽  
En Bloc ◽  
Primary Tumors ◽  
Entire Cohort

OBJECT Spinal chordomas can have high local recurrence rates after surgery with or without conventional dose radiation therapy (RT). Treatment outcomes and prognostic factors after high-dose proton-based RT with or without surgery were assessed. METHODS The authors conducted a retrospective review of 126 treated patients (127 lesions) categorized according to disease status (primary vs recurrent), resection (en bloc vs intralesional), margin status, and RT timing. RESULTS Seventy-one sacrococcygeal, 40 lumbar, and 16 thoracic chordomas were analyzed. Mean RT dose was 72.4 GyRBE (relative biological effectiveness). With median follow-up of 41 months, the 5-year overall survival (OS), local control (LC), locoregional control (LRC), and distant control (DC) for the entire cohort were 81%, 62%, 60%, and 77%, respectively. LC for primary chordoma was 68% versus 49% for recurrent lesions (p = 0.058). LC if treated with a component of preoperative RT was 72% versus 54% without this treatment (p = 0.113). Among primary tumors, LC and LRC were higher with preoperative RT, 85% (p = 0.019) and 79% (0.034), respectively, versus 56% and 56% if no preoperative RT was provided. Overall LC was significantly improved with en bloc versus intralesional resection (72% vs 55%, p = 0.016), as was LRC (70% vs 53%, p = 0.035). A trend was noted toward improved LC and LRC for R0/R1 margins and the absence of intralesional procedures. CONCLUSIONS High-dose proton-based RT in the management of spinal chordomas can be effective treatment. In patients undergoing surgery, those with primary chordomas undergoing preoperative RT, en bloc resection, and postoperative RT boost have the highest rate of local tumor control; among 28 patients with primary chordomas who underwent preoperative RT and en bloc resection, no local recurrences were seen. Intralesional and incomplete resections are associated with higher local failure rates and are to be avoided.

scholarly journals Sagittal en bloc resection of primary tumors in the thoracic and lumbar spine: feasibility, safety and outcome

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Lei Dang ◽  
Zhongjun Liu ◽  
Xiaoguang Liu ◽  
Liang Jiang ◽  
Miao Yu ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Primary Tumors ◽  
Thoracic And Lumbar Spine

En Bloc Resection for Primary and Metastatic Tumors of the Spine

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 435-445 ◽  
Author(s):  
Jordan M. Cloyd ◽  
Frank L. Acosta ◽  
Mei-Yin Polley ◽  
Christopher P. Ames
Keyword(s):  
Disease Free Survival ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Spinal Tumors ◽  
Primary Group ◽  
Metastatic Tumors ◽  
En Bloc ◽  
Primary Tumors ◽  
Free Survival ◽  
Disease Free

Abstract BACKGROUND The efficacy of en bloc resection for spinal tumors is unknown because most of the current evidence is provided by small, single-institution clinical series or case reports. OBJECTIVE To combine all previously published reports of en bloc resection for primary and metastatic spinal tumors, to describe the overall pattern of disease-free survival, and to investigate potentially prognostic factors for recurrence. METHODS A complete MEDLINE search for all articles reporting survival data for en bloc resection of spinal tumors was undertaken; 44 articles met inclusion criteria from which 306 eligible patients were identified. RESULTS There were 229 cases of primary tumors with a mean follow-up of 65.0 months and 77 cases of solitary metastatic tumors with a mean follow-up of 26.5 months. Median time to recurrence was 113 months for the primary group and 24 months for the metastatic group. Disease-free survival rates at 1, 5, and 10 years were 92.6%, 63.2%, and 43.9%, respectively, for the primary group and 61.8%, 37.5%, and 0%, respectively, for the metastatic group; 5-year disease-free survival rates were 58.4% for chordoma and 62.9% for chondrosarcoma. After adjusting for covariates, age, male sex, metastatic tumors, and osteosarcomas were significantly associated with a tumor recurrence. CONCLUSION This study provides the largest published series of patients undergoing en bloc resection for spinal tumors. Median time to recurrence reached almost 10 years in patients with primary tumors; however, it was only 2 years in those with isolated metastatic tumors.

Leiomyogenic tumor of the spine: surgical treatments and long-term outcomes of 12 consecutive patients

2020 ◽  
Vol 32 (1) ◽  
pp. 89-97
Author(s):  
Shaohui He ◽  
Yuduo Xu ◽  
Jialin Li ◽  
Yue Zhang ◽  
Haifeng Wei ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Ki 67 ◽  
Factors Affecting ◽  
The Mean ◽  
Piecemeal Resection

OBJECTIVELeiomyogenic tumor of the spine is rare with limited published information. Here, the authors report the clinical features and long-term surgical outcomes and investigate the prognostic factors affecting disease-free survival (DFS).METHODSTwelve patients presented to the authors’ institution for surgical treatment from January 2005 to December 2018. The clinical characteristics and outcomes were retrospectively reviewed, and the DFS rate was estimated using the Kaplan-Meier method. The log-rank test was used to identify the potential prognostic factors, with p < 0.05 considered statistically significant.RESULTSThe mean patient age was 49.7 ± 12.9 years (range 22–73 years). Four patients underwent marginal en bloc resection, and 8 patients underwent conventional piecemeal resection. Pathological diagnosis revealed leiomyosarcoma in 9 patients and leiomyoma in 3 patients. Three patients had tumor recurrence at a mean follow-up of 10.4 months (range 7.0–15.0 months), while 4 developed metastases at an average of 13.8 months (range 5.5–21.3 months) postoperatively. During the mean follow-up of 33.7 months (range 9.6–78.5 months), the estimated 1- and 5-year DFS rates were 66.7% and 38.2%, respectively. Albumin loss > 20 g/L after surgery, Ki-67 positivity > 10%, and piecemeal resection were correlated with worse DFS.CONCLUSIONSSurgical management of spinal leiomyogenic tumors is challenging due to the high rate of recurrence and metastases. En bloc resection should be performed in eligible patients. Albumin loss > 20 g/L and the Ki-67 index may be independent factors affecting prognosis.

scholarly journals Transarterial Embolization Treatment of Sacral Tumors

2018 ◽  
Vol 1 (Supplement) ◽  
pp. 35
Author(s):  
D. Anghelescu ◽  
E. Popescu ◽  
A. Cursaru ◽  
A. Dimitriu ◽  
R. Ene ◽  
...  
Keyword(s):  
Blood Loss ◽  
Late Onset ◽  
Transarterial Embolization ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Recurrence Rates ◽  
En Bloc ◽  
Complete Excision ◽  
Perioperative Blood Loss ◽  
Sacral Tumors

Abstract Objectives. Sacral tumors represent about 1-4,3% of all bone tumors. They typically present with an abundance of blood vessels. Due to their anatomical localization, they are hard to approach surgically. Thus, a presurgical neoadjuvant therapy is indicated. The preoperative angiography with the embolization of the nutritive arteries decreases the perioperative blood loss and the symptomatology, and even decreases the volume of the tumors that cannot be surgically approached. Materials and methods. The principle of embolization consists in the targeting of the nutritive tumoral artery and in obturating it with embolic agents (polyvinyl alcohol, embospheres, etc.) through selective catheterization under angiographic control. The biopsy of the tumor is essential for certain diagnosis. The histological type of the tumor and the degree of differentiation influence the tumor’s physiopathology and often influence the therapeutic decision regarding its degree or recurrence. In some cases in which the tumor’s degree of extension increases the surgical risk, serial embolization can be used as a primary method of treatment. Because of the late onset symptomatology, when they are discovered they are extended and the degree of invasion in adjacent tissues is so high that it requires en bloc resection with nerve root sacrifice to assert complete excision and low recurrence rates. Results. The patients who undergo surgical treatment usually bleed, and the perioperative blood loss and the need for blood transfusion volumes were halved in the cases in which presurgical transarterial embolization was performed. Conclusions. Transarterial embolization of sacral tumors is a procedure indicated as a neoadjuvant presurgical therapy to decrease the blood loss risks and for the tumors that cannot be surgically removed it is used in the palliative treatment to reduce symptomatology.

scholarly journals THE USE OF DENOSUMAB IN GIANT CELL TUMORS IN THE SACRUM

2020 ◽  
Vol 19 (2) ◽  
pp. 151-153
Author(s):  
PEDRO LUIS BAZÁN ◽  
RENATA DI FALCO ◽  
ALVARO ENRIQUE BORRI ◽  
MARTÍN MEDINA ◽  
NICOLÁS MAXIMILIANO CICCIOLI ◽  
...  
Keyword(s):  
Giant Cell ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Weekly Dose ◽  
Giant Cell Tumors ◽  
En Bloc ◽  
Level Of Evidence ◽  
Primary Tumors ◽  
Advanced Stages ◽  
Treatment Surgery

ABSTRACT Giant Cell Tumor (GCT), a benign tumor with local aggression, corresponds to 5% of primary tumors. Fifteen percent of these are located in the sacrum. En bloc resection is an effective treatment, but when it cannot be performed, Denosumab may be indicated as an alternative treatment. The objectives of this work are: to justify the indication; determine the best dose and time of use; and recognize the need for post-treatment surgery. Methods A systematic search of clinical trials. Twenty-five articles were selected, ten of which met the inclusion criteria. The use of Denosumab is justified in advanced stages, with a dose of 120 mg administered subcutaneously, every 7 days in the first month and then maintained every 4 weeks, for 2.5 to 13 months. Adverse events are mild and can be observed in 84% of patients. With Denosumab, surgery may be less aggressive or even unnecessary. The bibliography justifies the indication of Denosumab in advanced stages of GCT, with a dose of 120 mg administered subcutaneously; there is no consensus as to the maintenance dose, which is a weekly dose in the first month and then every four weeks for 2.5 to 13 months. Complications are frequent but mild. Level of evidence III; Systematic review.

scholarly journals Pelvic Chondrosarcoma Treated by En Bloc Resection with Patient-Specific Osteotomy Guides and Reimplantation of the Extracorporeally Irradiated Bone as an Osseocartilaginous Structural Orthotopic Autograft: A Report of Two Cases with Description of the Surgical Technique

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Georgios Gkagkalis ◽  
Kevin Moerenhout ◽  
Hannes A. Rüdiger ◽  
Daniel A. Müller ◽  
Igor Letovanec ◽  
...  
Keyword(s):  
Computer Navigation ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Patient Specific ◽  
En Bloc ◽  
Primary Tumors ◽  
Complex Anatomy ◽  
Custom Made ◽  
Patient Specific Instruments ◽  
Modular Prostheses

Primary tumors of the pelvis are considered difficult to treat due to the complex anatomy and the proximity of important neurovascular structures. The surgical armamentarium for the treatment of these tumors has evolved with the help of cutting-edge technology from debilitating hemipelvectomies to solutions such as precise resections guided by patient-specific instruments or computer navigation and reconstruction by modular prostheses, 3D-printed custom-made implants, or orthotopic autograft reimplantation after extracorporeal irradiation. Different combinations of these techniques have been described in the literature with various rates of success. We present two cases of pelvic chondrosarcomas successfully treated by a combination of periacetabular resection with patient-specific osteotomy guides and orthotopic reimplantation of the extracorporeally irradiated autograft resulting in retention of the native hip.

Fainting as an unusual presentation of a large inferior vena cava leiomyosarcoma

2014 ◽  
Vol 30 (7) ◽  
pp. 492-495
Author(s):  
Giuseppe Massimiliano De Luca ◽  
Angela Gurrado ◽  
Andrea Marzullo ◽  
Giuseppe Piccinni ◽  
Riccardo Memeo ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Histopathological Examination ◽  
Vena Cava ◽  
En Bloc Resection ◽  
Postoperative Recovery ◽  
Bloc Resection ◽  
Whole Body ◽  
En Bloc ◽  
Primary Tumors

Objectives Primary tumors of the inferior vena cava are rare, with leiomyosarcoma representing the vast majority. Method A 60-year-old man was admitted in emergency for fainting and mild anemia. A whole-body computed tomography revealed a retroperitoneal mass of approximately 8 cm in diameter, invading the lumen of the inferior vena cava, extending to the renal vein confluence. An en bloc resection of the solid mass was performed. Macroscopically the tumor did not seem to insist on the resection margin. Results Histopathological examination confirmed the diagnosis of leiomyosarcoma of the inferior vena cava. Postoperative recovery was uneventful and the patient was discharged after eight days, starting adjuvant chemotherapy. During the follow-up, the patient did not show other fainting episode, and at 24 months he is disease free. Conclusions: Unusually, fainting could even be the isolated sign of a large leiomyosarcoma of the inferior vena cava, also when it affects its middle portion.

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