Posterior-Only Approach for En Bloc Sacrectomy

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 357-364 ◽  
Author(s):  
Michelle J. Clarke ◽  
Hormuzdiyar Dasenbrock ◽  
Ali Bydon ◽  
Daniel M. Sciubba ◽  
Matthew J. McGirt ◽  
...  
Keyword(s):  
Medical Records ◽  
Spinal Column ◽  
Oncologic Outcome ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Tumor Type ◽  
En Bloc ◽  
Sacral Resection ◽  
Sacral Tumors ◽  
Biomechanical Reconstruction

Abstract BACKGROUND: En bloc resection of primary sacral tumors has a demonstrated survival benefit. Total and high sacral amputations are traditionally performed by using a staged anterior and subsequent posterior approach. However, we have found that en bloc resection and biomechanical reconstruction of the spinal column is possible from a posterior-only approach in many cases. OBJECTIVE: To assess our series of posterior-only sacrectomies, emphasizing postoperative complications and overall surgical and oncologic outcome. METHODS: Sixty-nine consecutive patients underwent sacral resections for tumor at our institution between 2004 and 2009. Medical records of all patients were reviewed, and patients were excluded if they had an intentional intralesional resection, hemipelvectomy, or a previous operation. The records of the resulting 36 consecutive patients who underwent primary posterior-only en bloc sacral resections were retrospectively reviewed. RESULTS: Of the posterior-only patients, all underwent midline posterior approaches for en bloc sacral resection. Sacral amputation was defined by the by sacral root preservation: total (2 cases), high (8 cases), middle (9 cases), low (12 cases), and distal (5 cases). Chordoma was the most common tumor type (30 cases), and surgical margins were marginal in 34 cases and contaminated in 2. Overall, there were 13 complications, including 9 wound infections/revisions. The extent of sacrectomy, and thus the extent of roots sacrificed, correlated with functional outcome. CONCLUSION: It may be possible to perform a posterior-only approach to en bloc sacral resections/reconstructions in patients with tumors that do not extend beyond the lumbosacral junction or invade the bowel requiring bowel resection and diversion.

scholarly journals Sacroplasty Augmentation of Instrumented Pelvic Reconstruction After High Sacrectomy: A Technical Case Report

2021 ◽  
Author(s):  
Amanda N Sacino ◽  
Sutipat Pairojboriboon ◽  
Ian Suk ◽  
Daniel Lubelski ◽  
Robin Yang ◽  
...  
Keyword(s):  
Mechanical Stability ◽  
Pelvic Ring ◽  
Surgical Techniques ◽  
Extent Of Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Mobile Spine ◽  
Sacral Tumors ◽  
Fibrous Tumor

Abstract BACKGROUND AND IMPORTANCE En bloc resection of sacral tumors is the most effective treatment to help prevent recurrence. Sacrectomy, however, can be destabilizing, depending on the extent of resection. Various surgical techniques for improving stability and enabling early ambulation have been proposed. CLINICAL PRESENTATION Here, we report a case in which we use PMMA (poly[methyl methacrylate]) to augment pelvic instrumentation to improve mechanical stability after sacrectomy for en bloc resection of a solitary fibrous tumor. CONCLUSION We highlight the use of sacroplasty augmentation of pelvic ring reconstruction to provide biomechanical stability without the need for fusion of any mobile spine segments, which allowed for early patient ambulation and no appreciable loss of range of motion or mobility.

Interest of Laparoscopy for “En Bloc” Resection of Primary Malignant Sacral Tumors by Combined Approach

Spine ◽  
2015 ◽  
Vol 40 (19) ◽  
pp. 1542-1552 ◽  
Author(s):  
Arnaud Dubory ◽  
Gilles Missenard ◽  
Benoît Lambert ◽  
Charles Court
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Combined Approach ◽  
En Bloc ◽  
Sacral Tumors

En bloc resection of primary sacral tumors: classification of surgical approaches and outcome

2005 ◽  
Vol 3 (2) ◽  
pp. 111-122 ◽  
Author(s):  
Daryl R. Fourney ◽  
Laurence D. Rhines ◽  
Stephen J. Hentschel ◽  
John M. Skibber ◽  
Jean-Paul Wolinsky ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Approaches ◽  
En Bloc ◽  
Sacral Tumors ◽  
Tumors Classification

Total spondylectomy for en bloc resection of lung cancer invading the chest wall and thoracic spine

2004 ◽  
Vol 100 (4) ◽  
pp. 353-357 ◽  
Author(s):  
Masashi Komagata ◽  
Makoto Nishiyama ◽  
Atshuhiro Imakiire ◽  
Hirobumi Kato
Keyword(s):  
Lung Cancer ◽  
Chest Wall ◽  
Thoracic Spine ◽  
Spinal Column ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Term Survival ◽  
Content Type ◽  
Fine Print

✓ Lung cancers invading the chest wall and spinal column are often considered unresectable, and consequently there are few reports describing resection of invasive vertebral lesions. The authors developed a new anterior approach procedure for the en bloc resection of primary lung adenocarcinoma invading the thoracic spine and chest wall, in which the primary tumor does not need to be separated from the vertebrae. The authors describe a total spondylectomy for the en bloc resection of lung cancer invading the spine. A combination of surgical techniques was required, including resection of the osseous elements T-2 and T-3 (the pedicles were excised using a thread saw), anterolateral thoracotomy, apical lobectomy, chest wall resection, vertebrectomy, anterior spinal column reconstruction with a titanium mesh cage containing bioactive glass ceramic, and placement of anterior and posterior spinal instrumentation. At 46 months after surgery, there is no evidence of local recurrence or distant metastasis, and the patient continues to improve. This new procedure allows for the en bloc resection of primary lung tumors and adherent vertebral invasion without separation of the lesion from the vertebra. Thus, surgical management by complete excision of Pancoast tumors can achieve longer-term survival rates without sequelae.

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.

Primary Tumors of the Spine

2018 ◽  
Author(s):  
Martin H. Pham ◽  
Patrick C. Hsieh
Keyword(s):  
Multidisciplinary Approach ◽  
Tumor Biology ◽  
Spinal Column ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Debulking Surgery ◽  
En Bloc ◽  
Primary Tumors ◽  
Spinal Reconstruction ◽  
Preoperative Counseling

Primary tumors of the spinal column are rare. Computed tomography–guided biopsy is typically performed to make the diagnosis and plan the next steps in treatment. For some primary spinal column tumors, such as osteosarcoma, en bloc resection based on the Enneking classification and extensive spinal reconstruction may be indicated. Significant surgical complications are possible with en bloc resection, and extensive preoperative counseling is required. Patients with pre-existing metastatic disease will likely not benefit from en bloc resection and instead may undergo debulking surgery based on neurologic symptoms. Tumor biology and an assessment of margins dictate possible adjuvant therapy. A multidisciplinary approach is essential in managing these patients.

scholarly journals Usefulness of epinephrine-added injection solution to reduce procedure time for gastric endoscopic submucosal dissection

2020 ◽  
Vol 08 (08) ◽  
pp. E1044-E1051
Author(s):  
Shuntaro Inoue ◽  
Noriya Uedo ◽  
Takahiro Tabuchi ◽  
Kentaro Nakagawa ◽  
Masayasu Ohmori ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Tumor Type ◽  
Procedure Time ◽  
Injection Solution ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Significant Difference

Abstract Background and study aims Epinephrine-added submucosal injection solution is used to facilitate hemostasis of non-variceal upper gastrointestinal bleeding and to prevent delayed bleeding of large pedunculated colorectal lesions. However, its benefit in gastric endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is unclear. The effectiveness of epinephrine-added injection solution for outcomes of gastric ESD was examined using propensity score matching analysis. Patients and methods A total of 1,599 patients with solitary EGC (83 with non-epinephrine-added solution and 1,516 with epinephrine-added solution) between 2011 and 2018 were enrolled. Propensity scores were calculated to balance the distribution of baseline characteristics: age, sex, tumor location, specimen size, presence of ulcer scar, tumor depth, histological tumor type, and operators’ experience, and 1:3 matching was performed. En bloc resection rate, mean procedure time, delayed bleeding rate, and perforation rate were compared between the non-epinephrine (n = 79) and epinephrine (n = 237) groups. Results Mean procedure time was significantly shorter in the epinephrine group than in the non-epinephrine group (60 vs. 78 min, P < 0.001). No significant difference was found in the rate of en bloc resection (both 99 %), incidence of delayed bleeding (both 6 %), or perforation (0 vs. 0.8 %) between the two groups. In multiple linear regression analysis, use of epinephrine-added solution was independently associated with short procedure time (P < 0.001) after adjustment for other covariates. Conclusion The results suggest that epinephrine-added injection solution is useful for reduction of gastric ESD procedure time, warranting validation in a randomized controlled trial.

Midsacral Amputation for En Bloc Resection of Chordoma

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-41-ons-44 ◽  
Author(s):  
Ganesh Rao ◽  
George J. Chang ◽  
Ian Suk ◽  
Ziya Gokaslan ◽  
Laurence D. Rhines
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Margins ◽  
En Bloc ◽  
Sacral Chordoma ◽  
Sacral Tumor ◽  
Tumors Of The Sacrum ◽  
Successful Removal ◽  
Sacral Tumors

Abstract Background: En bloc resection, with adequate surgical margins, of primary malignant bone tumors of the sacrum is associated with long term disease control and potential cure. Resection of sacral tumors is difficult due to the proximity of neurovascular and visceral structures, and complete, or even partial, sacrectomy often results in functional loss for the patient. Objective: We describe the technique for en bloc resection of a sacral chordoma through a mid-sacral amputation. Results: We demonstrate successful removal of a large sacral tumor with wide surgical margins while preserving neurologic function. Conclusion: This technique for midsacral amputation to remove a sacral tumor en bloc minimizes local recurrence and maximizes neurovascular function.

scholarly journals Surgical classification of different types of en bloc resection for primary malignant sacral tumors

2011 ◽  
Vol 20 (12) ◽  
pp. 2275-2281 ◽  
Author(s):  
Dasen Li ◽  
Wei Guo ◽  
Xiaodong Tang ◽  
Tao Ji ◽  
Yidan Zhang
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Different Types ◽  
Sacral Tumors
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