scholarly journals Oncological principles in spinal tumor surgery

2021 ◽  
Vol 18 (2) ◽  
pp. 64-72
Author(s):  
N. S. Zaborovskii ◽  
D. A. Ptashnikov ◽  
D. A. Mikhaylov ◽  
O. A. Smekalenkov ◽  
S. V. Masevnin
Keyword(s):  
Personal Experience ◽  
Resection Margin ◽  
Complete Removal ◽  
Spinal Tumor ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Spinal Tumors ◽  
En Bloc ◽  
Single Block ◽  
The Sacrifice

Surgical intervention remains the cornerstone of the treatment of patients with spinal tumors. The presented literature review includes also the authors’ personal experience in the treatment of tumors. Pain relief, local control of a neoplasm growth and preservation of body functions are the main goals of this pathology treatment.Treatment of spinal tumors is based on the biology, location and extent of the neoplasm. If surgical treatment is indicated, en-bloc resection is the preferred method. This operation is based on the complete removal of the tumor in a single block entirely covered by a shell of healthy tissue. This surgical procedure can be challenging due to the proximity of the neural structures. Moreover, achieving clean resection margin around the tumor often requires the sacrifice of adjacent anatomic structures. A more comprehensive approach requires a combination of surgery, systemic therapy and radiotherapy to improve outcomes in patients with advanced spinal tumors.The fulfillment of oncological principles is fundamental to achieving best treatment outcomes for spinal tumors.

Augmented reality–mediated stereotactic navigation for execution of en bloc lumbar spondylectomy osteotomies

2021 ◽  
pp. 1-6
Author(s):  
Camilo A. Molina ◽  
Christopher F. Dibble ◽  
Sheng-fu Larry Lo ◽  
Timothy Witham ◽  
Daniel M. Sciubba
Keyword(s):  
Augmented Reality ◽  
Surgical Navigation ◽  
New Technology ◽  
Spinal Tumor ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
High Morbidity ◽  
En Bloc ◽  
Stereotactic Navigation ◽  
Workflow Efficiency

En bloc spinal tumor resections are technically demanding procedures with high morbidity because of the conventionally large exposure area and aggressive resection goals. Stereotactic surgical navigation presents an opportunity to perform the smallest possible resection plan while still achieving an en bloc resection. Augmented reality (AR)–mediated spine surgery (ARMSS) via a mounted display with an integrated tracking camera is a novel FDA-approved technology for intraoperative “heads up” neuronavigation, with the proposed advantages of increased precision, workflow efficiency, and cost-effectiveness. As surgical experience and capability with this technology grow, the potential for more technically demanding surgical applications arises. Here, the authors describe the use of ARMSS for guidance in a unique osteotomy execution to achieve an en bloc wide marginal resection of an L1 chordoma through a posterior-only approach while avoiding a tumor capsule breach. A technique is described to simultaneously visualize the navigational guidance provided by the contralateral surgeon’s tracked pointer and the progress of the BoneScalpel aligned in parallel with the tracked instrument, providing maximum precision and safety. The procedure was completed by reconstruction performed with a quad-rod and cabled fibular strut allograft construct, and the patient did well postoperatively. Finally, the authors review the technical aspects of the approach, as well as the applications and limitations of this new technology.

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.

scholarly journals Spondylectomy in the Treatment of Neoplastic Spinal Lesions – A Retrospective Outcome Analysis of 582 Patients Using a Patient-Level Meta-Analysis

2020 ◽  
pp. 1-8
Author(s):  
Alexander Spiessberger ◽  
Alexander Spiessberger ◽  
Varun Arvind ◽  
Mansoor Nasim ◽  
Basil Grueter ◽  
...  
Keyword(s):  
Overall Survival ◽  
Postoperative Complications ◽  
Odds Ratio ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Spinal Tumors ◽  
En Bloc ◽  
En Bloc Spondylectomy ◽  
Patient Level ◽  
Bloc Spondylectomy

Background: En-bloc spondylectomy in the treatment of spinal tumors is a complex procedure with potential complications. This study aims at identifying predictors of postoperative complications, lesion recurrence and overall survival. Methods: A systematic review of the literature was conducted, and patient-level data extracted from the included studies. Multiple linear-regression models were calculated to predict the occurrence of postoperative complications, lesion recurrence and overall survival based on age, tumor etiology, surgical approach, mode of resection (en-bloc versus intralesional), tumor extension based on Weinstein-BorianiBiagini classification system and number of levels treated. Results: Data of 582 individual adult and pediatric patients were extracted from the literature; Patient characteristics are: 45% female, median age of 46 years (range 5-78); most common etiologies were: sarcoma (46%), metastases (31%) and chordoma (11%). The surgical technique was: anterior (2.5%), combined (45%) and posterior approach (52.4%); 68.5% underwent en-bloc spondylectomy; average levels resected were 1.6 (1-6); 65% of patients had neurologic deficits at presentation, average survival was 2.6 years; Direct procedure-related complications were observed in 17.7%, with the most prevalent being CSF leaks, wound infections and neural injury. For postoperative complications, recurrence and 5-year survival significant regression equations were found (F(7,90)=2.57, p=0.018) with an R2 of 0.1; (F(5,147)=2.35, p=0.044) with an R2 of 0.07 and (F(4,101)=7.2, p=0.01) with an R2 of 0.38. Odds ratio for predicted complications was 1.35 for en-bloc resection and 1.25 for more than one level treated. The odds ratio for tumor recurrence was 0.78 for en-bloc resection; odds ratio for 5-year survival were 0.79 for increased patient age, 0.65 for increasing tumor grade, 0.79 for tumor dissemination at diagnosis and 1.68 for en-bloc resection. Conclusion: En-bloc spondylectomy provides improved survival and lower recurrence rates but also higher operative complication rates when compared to intralesional resections. Interestingly the complication rate was not influenced by tumor stage (WBB scale) and tumor etiology.

scholarly journals Evaluation of Resection Margin after Image-Guided Dural Tail Resection in Convexity Meningiomas

2021 ◽  
Vol 10 (6) ◽  
pp. 1177
Author(s):  
Darius Kalasauskas ◽  
Yasemin Tanyildizi ◽  
Mirjam Renovanz ◽  
Marc A. Brockmann ◽  
Clemens J. Sommer ◽  
...  
Keyword(s):  
Tumor Cell ◽  
Resection Margin ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Tumor Infiltration ◽  
En Bloc ◽  
Image Guided ◽  
Dural Tail ◽  
Piecemeal Resection

Infiltration of adjacent dura with meningioma cells is a common phenomenon. Wide resection of the dural tail (DT) to achieve a gross total resection is a general recommendation. We aimed to investigate a tumor cell infiltration of the DT after image-guided resection of convexity meningiomas. The study’s inclusion criteria were the diagnosis of convexity meningioma, planned Simpson I° resection, and an identifiable DT. Intraoperative image-guidance was applied to identify the outer edge of the DT and to guide resection. After resection, en-bloc specimen or four samples of outermost pieces of DT in case of piecemeal resection were sent for histological analysis. In addition to resection margin infiltration, the radiological extent of DT, radiomic characteristics (109 in total), histology, and demographic data were assessed. Hierarchical clustering was used to generate patient clusters for radiomic analysis. Twenty-two patients were included in the study, while 20 (91%) were female. The mean age was 54.2 (Standard deviation (SD) 13.9, range 30–85) years. En-bloc resection could be achieved in 4 patients. The remaining patients received piecemeal resection. 2 DT samples were omitted due to tumor infiltration of the superior sagittal sinus. None of the en-bloc resection samples demonstrated dural infiltration on the resection margin. Tumor cells were detected in 4 of 70 (5.7%) dural tail samples and could not be excluded in another 5 of 70 (7.1%). No tumor recurrences were detected at follow-up MRI examinations after a mean follow-up of 27.5 (SD 13.2, range 0 to 50.0) months. There was no significant association between DT infiltration and histological subtype or patient characteristics and between DT extent and tumor infiltration. Clustering according to radiomic characteristics was not associated with tumor infiltration (p = 0.89). The radiological dural tail does not reliably outline the extent of tumor cell infiltration in convexity meningiomas. Hence, the extent of dural tail resection should not exclusively be guided by preoperative radiological appearance.

En Bloc Resection of Primary Spinal Tumors

2009 ◽  
Vol 21 (2) ◽  
pp. 93-98 ◽  
Author(s):  
Jason C. Eck ◽  
Mark B. Dekutoski
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Spinal Tumors ◽  
En Bloc

scholarly journals LASER EN-BLOC RESECTION OF NON-MUSCLE-INVASIVE BLADDER CANCER: CLINICAL AND MORPHOLOGICAL SPECIFICITIES

2018 ◽  
Vol 14 (3) ◽  
pp. 78-84
Author(s):  
L. O. Severgina ◽  
N. I. Sorokin ◽  
A. M. Dymov ◽  
D. G. Tsarichenko ◽  
D. V. Enikeev ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Resection Margin ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Postoperative Outcomes ◽  
Invasive Bladder Cancer ◽  
Low Grade ◽  
Muscle Invasive Bladder Cancer ◽  
En Bloc ◽  
Muscle Invasive

Objectives to enhance the morphological diagnostic complex in order to predict postoperative outcomes in a more accurate way and to optimize patients with non-muscular invasive bladder cancer treatment.Materials and methods. The study included 34 patients from 25 to 71 years old underwent laser en-block resection, the most of them were males – 28. In 9 cases multiple carcinomas (2 or more) were found. Huge tumors (2 cm or more in one dimension) were resected in 6 patients. Results. The major part of tumors removed (n = 22) histologically appeared to be papillary urothelial carcinomas with low grade of malignancy and PUNLMP; in 6 cases G2 was verified, one tumor with high malignancy potention – G3. In 3 patients intramuscular invasion was found (invasive carcinoma T2) excluding them from the study.Discussion. Laser en-block resection of non-muscle-invasive bladder cancer appears to be the most optimal approach in operative treatment that provides representative histological material. For correct morphological estimate we recommend either to expand the resection zone to 1 cm which allows to remove circular resection margin or to take extra pinch biopsy from tumor crater (vertical margin). In 3 patients from our study positive circular margin was revealed histologically whereas foci of perineural and perivascular invasion were found in one case. A new subgrading of stage T1 depending on intramuscular invasion depth was suggested whereas the main criteria is the muscularis mucosae involvement.Conclusion. Morphological estimate of circular resection margin provides an ability to predict postoperative outcomes and correct the treatment in one or another way. Subgrading for T1-stage tumors is recommended for following correct postoperative prognosis and possibility of tumor recurrence.

scholarly journals Large Retroperitoneal Perivascular Epithelioid Cell Neoplasm (PEComa): A Case Report and a Brief Review

2021 ◽  
pp. 1-6
Author(s):  
Giorgio Lucandri ◽  
Giorgio Lucandri ◽  
Marco Maria Lirici ◽  
Alessia Fassari ◽  
Vito Pende ◽  
...  
Keyword(s):  
Case Report ◽  
Immunohistochemical Staining ◽  
Correct Diagnosis ◽  
Distant Metastases ◽  
Complete Removal ◽  
En Bloc Resection ◽  
Epithelioid Cell ◽  
Bloc Resection ◽  
En Bloc ◽  
Perivascular Epithelioid Cell

Objective: To describe a case of retroperitoneal perivascular epithelioid cell tumor (PEComa) and to discuss the main features of this rare pathology. Introduction: PEComas represent a rare cluster of neoplasms with uncertain origin; their precursor cells are spindle-shaped and characterized by a myomelanocytic phenotype, so only immunohistochemical staining makes a definitive diagnosis possible. To date, less than three hundred cases are reported in Literature and retroperitoneal site accounts for 7-8% of overall locations. Case Report: Middle-aged female has visited for abdominal pain and urinary complaints; physical findings and imaging demonstrated a huge inhomogeneous mass occupying right abdomen and arising from renal capsule. After multidisciplinary evaluation, patient has been addressed to open surgery and an en-bloc resection of the mass, with right nephrectomy and adrenalectomy. Immunohistochemical staining made a diagnosis of PEComa possible. After an uneventful postoperative stay, the patient entered a follow up protocol, without signs of local recurrence and distant metastases. Conclusion: Retroperitoneal PEComa often presents as a bulky mass with renal and adrenal involvement. Surgical resection should be aimed to obtain a complete removal with negative margins; this makes compartment surgery and en-bloc resection mandatory. Immunostaining is the key methods for a correct diagnosis.

Biomimetic 3D-printed custom-made prosthesis for anterior column reconstruction in the thoracolumbar spine: a tailored option following en bloc resection for spinal tumors

2018 ◽  
Vol 27 (12) ◽  
pp. 3073-3083 ◽  
Author(s):  
Marco Girolami ◽  
Stefano Boriani ◽  
Stefano Bandiera ◽  
Giovanni Barbanti-Bródano ◽  
Riccardo Ghermandi ◽  
...  
Keyword(s):  
Thoracolumbar Spine ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Anterior Column ◽  
Spinal Tumors ◽  
En Bloc ◽  
Custom Made ◽  
3D Printed ◽  
Anterior Column Reconstruction

scholarly journals Contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection: a technique for oncological resection of posterolateral spinal tumors

2017 ◽  
Vol 26 (3) ◽  
pp. 275-281 ◽  
Author(s):  
Viren S. Vasudeva ◽  
Alexander E. Ropper ◽  
Samuel Rodriguez ◽  
Kyle C. Wu ◽  
John H. Chi
Keyword(s):  
Spinal Column ◽  
Progression Free Survival ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Spinal Tumors ◽  
High Morbidity ◽  
Low Grade ◽  
En Bloc ◽  
Bloc Spondylectomy ◽  
Pars Interarticularis

En bloc resection of tumors involving the spinal column is technically challenging and is associated with high morbidity to the patient due to the proximity of critical neurological and vascular structures and the destabilizing nature of this surgery. Nevertheless, evidence has shown improved progression-free survival with en bloc resection for certain low-grade malignant and aggressive benign musculoskeletal tumors. To avoid the morbidity of en bloc spondylectomy in patients with tumors localized to the lateral and posterolateral spinal column, the authors have found that the goals of surgery can be accomplished through a contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection (COPPER). They reviewed their series of 5 patients who underwent successful tumor removal through a COPPER approach. These patients were all found to harbor spinal column tumors involving the posterolateral elements that, based on pathology, would benefit from en bloc resection. Tumor pathology included chondrosarcoma, leiomyosarcoma, osteoblastoma, and liposarcoma. Resections were performed by completing ipsilateral facetectomies above and below the lesion and ipsilateral pedicle osteotomies from a contralateral approach following hemilaminectomy. By disarticulating the posterolateral elements while carefully protecting the thecal sac, the tumors were removed en bloc along with the affected lamina, pedicles, pars interarticularis, and spinous processes, allowing tumor-free margins. This technical report suggests that the COPPER approach is safe and effective for en bloc resection of tumors involving the posterolateral aspect of the spinal column with tumor-free margins and that it eliminates the need for anterior column reconstruction.

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

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.

Sign in / Sign up

Export Citation Format

Share Document