scholarly journals 360-surgery for a giant cervical chordoma with involvement of the right vertebral artery

2021 ◽  
Vol 12 ◽  
pp. 604
Author(s):  
Rodolfo Pedro Molina-Martínez ◽  
Venus Damaris Medina-Illueca ◽  
Carlos Betancourt-Quiroz ◽  
Daniel Alejandro Vega-Moreno ◽  
Andrés Alberto Moral-Naranjo ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Gold Standard ◽  
Malignant Tumors ◽  
Radical Resection ◽  
En Bloc ◽  
Postoperative Radiation Therapy ◽  
Staged Approach ◽  
The Right ◽  
Cervical Chordoma ◽  
Anterior Posterior

Background: Chordomas are malignant tumors that arise from the remnants of the notochord. Complete en bloc radical resection with postoperative radiation therapy is currently considered the gold standard. Here, we performed a 360-staged approach to manage a C3-C4 chordoma that involved the right vertebral artery. Case Description: A 40-year-old woman presented with a C3-C4 chordoma that invaded the right vertebral artery. She responded well to a circumferential approach including resection and stabilization. Conclusion: A 40-year-old woman with a C3-C4 spinal chordoma was optimally managed with a combined anterior/posterior surgical approach including decompression/fusion.

Simultaneous anterior—posterior approach for excision of malignant paraspinal tumor and subsequent reconstruction

1999 ◽  
Vol 91 (2) ◽  
pp. 236-240 ◽  
Author(s):  
Kazuhiro Hasegawa ◽  
Akira Ogose ◽  
Hiroto Kobayashi ◽  
Tetsuro Morita ◽  
Yasuharu Hirata
Keyword(s):  
Posterior Approach ◽  
Malignant Tumors ◽  
Lateral Position ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Content Type ◽  
Spinal Reconstruction ◽  
The Right ◽  
Anterior Posterior

✓ In cases of primary malignant extradural tumors of the spine, the main goal of the surgery is en bloc resection and reconstruction of the spine. After placing the patient in the lateral position, an en bloc resection of a chondrosarcoma that arose from the right seventh rib head and invaded the adjacent vertebra was performed using a simultaneous anterior—posterior approach followed by spinal reconstruction. The technical details are reported. Paraspinal malignant tumors of the thoracic spine can be safely removed en bloc and the spine reconstructed using this approach.

En bloc resection of a multilevel high-cervical chordoma involving C-2: new operative modalities

2013 ◽  
Vol 19 (2) ◽  
pp. 232-242 ◽  
Author(s):  
Kern H. Guppy ◽  
Indro Chakrabarti ◽  
Richard S. Isaacs ◽  
Jae H. Jun
Keyword(s):  
Vertebral Artery ◽  
Survival Rates ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Hardware Failure ◽  
Spinal Reconstruction ◽  
Custom Design ◽  
High Cervical ◽  
Cervical Chordoma

En bloc resection of cervical chordomas has led to longer survival rates but has resulted in significant morbidities from the procedure, especially when the tumor is multilevel and located in the high-cervical (C1–3) region. To date, there have been only 5 reported cases of multilevel en bloc resection of chordomas in the high-cervical spine. In this technical report the authors describe a sixth case. A complete spondylectomy was performed at C-2 and C-3 with spinal reconstruction and stabilization, using several new modalities that were not used in the previous cases. The use of 1) preoperative endovascular sacrificing of the vertebral artery, 2) CT image-guidance, 3) an ultrasonic aspirator for skeletonizing the vertebral artery, and 4) the custom design of an anterior cage all contributed to absence of intraoperative or long-term (20 months) hardware failure and pseudarthrosis.

scholarly journals Outstanding issues of surgical treatment of locally advanced forms of malignant tumors

2020 ◽  
Vol 21 (4) ◽  
pp. 269-274
Author(s):  
V.V. Egorenkov ◽  
K.A. Andreychuk ◽  
M.S. Molchanov ◽  
E.V. Kuleshova
Keyword(s):  
Surgical Treatment ◽  
Malignant Tumors ◽  
Locally Advanced ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Considerable Uncertainty ◽  
Histological Factors ◽  
The Right ◽  
Complete Tumor

Nowadays surgery is still the mainstay of solid tumors treatment. En Bloc resection is surgical treatment in amount of complete tumor removal. There remains considerable uncertainty about many aspects of resection boundaries, including definition and influence of anatomical and histological factors. One of the biggest challenges for the surgeon is choosing the right surgery for the «right» patient, taking into account the type of tumor and its biology.

scholarly journals Resectable single hepatic epithelioid hemangioendothelioma in the left lobe of the liver: a case report

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 456-459
Author(s):  
Jun-Ke Wang ◽  
Zhen-Ru Wu ◽  
Fei Su ◽  
Wen-Jie Ma ◽  
Hai-Jie Hu ◽  
...  
Keyword(s):  
Multimodal Treatment ◽  
Malignant Tumors ◽  
Radical Resection ◽  
Left Lobe ◽  
Epithelioid Hemangioendothelioma ◽  
Good Survival ◽  
Vascular Origin ◽  
Good Survival Outcome ◽  
Rare Malignancy ◽  
The Right

AbstractHepatic epithelioid hemangioendothelioma (HEHE) is an extremely rare malignancy of vascular origin. When most patients with HEHE are diagnosed, they have a diffuse nodular phenotype, which is usually unresectable. A single nodular phenotype is found in only a small proportion (13%) of patients, and most are reported to be located in the right lobe of the liver. Although the prognosis of HEHE is considered more favorable than that of other hepatic malignant tumors, the 5-year survival rate is reported to be 64% after treatment. Herein, we present an unusual case of resectable HEHE of a single nodular type in the left lobe of the liver. The patient survived 15 years without recurrence after the multimodal treatment of radical resection and postoperative chemotherapy with thalidomide. The aim of the present study is to emphasize that multimodal treatment of radical resection followed by chemotherapy with thalidomide may achieve a relatively good survival outcome in patients with resectable HEHE of a single nodular type.

Myofibrosarcoma of the Adrenal Gland

2005 ◽  
Vol 71 (3) ◽  
pp. 191-193
Author(s):  
S.A. Mclaughlin ◽  
T.M. Schmitt ◽  
K.L. Huguet ◽  
D.M. Menke ◽  
J.H. Nguyen
Keyword(s):  
Adrenal Gland ◽  
Adrenal Mass ◽  
Soft Tissues ◽  
Malignant Tumors ◽  
Low Grade ◽  
En Bloc ◽  
First Case ◽  
Pathologic Features ◽  
Adrenal Masses ◽  
The Right

Adrenal masses have varying presentations. Most commonly, adrenal masses are discovered incidentally on CT or MRI during an evaluation for an unrelated complaint. Although the majority of these are nonfunctional cortical adenomas, hormonally active tumors and adrenocortical carcinoma must also be considered in the differential diagnosis. Rarely, retroperitoneal tumors may mimic an adrenal mass. We report a case of a 49-year-old man with anemia and weight loss who was found to have a large retroperitoneal mass arising from the adrenal gland. Surgical treatment involved en bloc resection of the right kidney, adrenal gland, segments 7 and 8 of the liver, and a portion of the right hemidiaphragm. Final pathology revealed a low-grade myofibrosarcoma. We believe that this is the first case report of a myofibrosarcoma of the adrenal gland. Myofibrosarcomas are rare malignant tumors composed of myofibroblasts that arise from the deep soft tissues. These tumors have a predilection for the head and neck, trunk, or extremities. Myofibrosarcomas can be differentiated from other sarcomas by immunohistochemical staining and pathologic features. We will briefly discuss the workup of an adrenal mass and focus on the diagnosis of myofibrosarcoma.

Two-Stage En Bloc Resection of Multilevel Cervical Chordomas With Vertebral Artery Preservation: Operative Technique

2017 ◽  
Vol 14 (5) ◽  
pp. 538-545 ◽  
Author(s):  
Xingwen Wang ◽  
Eldan Eichbaum ◽  
Fengzeng Jian ◽  
Dean Chou
Keyword(s):  
Vertebral Artery ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Nerve Roots ◽  
Cervical Nerve ◽  
En Bloc ◽  
Bloc Spondylectomy ◽  
En Bloc Excision ◽  
Bloc Excision ◽  
Cervical Chordoma

Abstract BACKGROUND En bloc excision of cervical chordoma is a technically complex procedure, due to the involvement and closeness of the tumor to the spinal cord, cervical nerve roots, and vertebral arteries. Studies have previously shown that en bloc excision of chordomas with negative margins improves local control and prolongs disease-free survival compared with intralesional excision. True en bloc spondylectomy in the cervical spine is not feasible since bilateral vertebral artery sacrifice is not possible. However, for lateralized tumors, en bloc excision of chordoma can be performed with unilateral vertebral artery preservation by parasagittal osteotomy. OBJECTIVE To describe the operative technique of performing en bloc excision of cervical chordoma via parasagittal osteotomy. METHODS Four patients underwent en bloc excision of multilevel cervical chordomas via parasagittal osteotomy between 2008 and 2016. These 4 cases of chordoma were at the upper-cervical, mid-cervical, and cervicothoracic regions. We analyzed the tumor location, oncological staging, surgical technique, and perioperative complications. RESULTS All 4 patients underwent en bloc excision of chordoma with expandable cage reconstruction and posterior instrumentation. Cervical nerve roots were sacrificed in 2 patients, and vertebral artery ligation was performed in 3 patients. Complications include new neurologic deficit, implant failure, and pharyngeal erosion after radiation. No tumor recurrence was seen. CONCLUSION Parasagittal osteotomy is a useful alternative to en bloc spondylectomy in the treatment of lateralized multilevel cervical chordoma, preserving one vertebral artery while still achieving an en bloc resection.

Surgical management of chordomas of the cervical spine

2007 ◽  
Vol 6 (5) ◽  
pp. 398-406 ◽  
Author(s):  
Ignacio J. Barrenechea ◽  
Noel I. Perin ◽  
Aymara Triana ◽  
Jonathan Lesser ◽  
Peter Costantino ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Tumor Resection ◽  
Radical Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Anterior Fusion ◽  
En Bloc ◽  
Stabilization Procedure ◽  
Second Resection ◽  
Cervical Chordoma

Object Chordomas of the cervical spine are rare tumors. Although en bloc resection has proven to be the ideal procedure in other areas, there is controversy regarding this approach in the cervical spine. The goal in this study was to determine whether piecemeal tumor resection was efficient in the management of chordomas that arise in this location. Methods The authors retrospectively reviewed all 74 cases of chordoma treated by their group. Seven patients with isolated cervical chordomas who were treated between October 1992 and January 2006 were identified. There were four male and three female patients, whose ages ranged from 6 to 61 years (mean 34.4 years). Follow-up duration ranged from 7 to 169 months (median 23 months). All cases were managed using a retrocarotid approach with mobilization of the vertebral artery. When the tumor could not be completely resected via the initial anterior approach, a subsequent posterior resection was performed. Tumor resection was intralesional in all cases, and gross-total tumor resection was achieved in six cases. One patient required a second resection 4 months later. In all cases, a posterior stabilization procedure was performed. Five patients underwent anterior fusion (three with fibular allograft and two with iliac crest), whereas two underwent occipitocervical fusion. In two patients with dedifferentiated chordoma metastasis developed, and one of them died 7 months later. The other patient with metastasis died suddenly at home 26 months postsurgery, presumably from aspiration. At the time of this submission, there were no signs of recurrence in five patients. Conclusions The authors believe that, in most cases, en bloc resection of cervical chordoma is not feasible. This is due to the tendency of chordomas to involve multiple compartments at the time of diagnosis. In the authors' experience, intralesional radical resection remains an effective surgical approach to this disease entity.

En bloc resection of multilevel cervical chordoma with C-2 involvement

2005 ◽  
Vol 2 (2) ◽  
pp. 199-205 ◽  
Author(s):  
Laurence D. Rhines ◽  
Daryl R. Fourney ◽  
Abdolreza Siadati ◽  
Ian Suk ◽  
Ziya L. Gokaslan
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Biological Behavior ◽  
Upper Cervical Spine ◽  
En Bloc ◽  
Content Type ◽  
Upper Cervical ◽  
The Right ◽  
Cervical Chordoma ◽  
Fine Print

✓ Chordomas are locally aggressive neoplasms with an extremely high propensity to recur locally following resection, despite adjuvant therapy. This biological behavior has led most authors to conclude that en bloc resection provides the best chance for the patient's prolonged disease-free survival and possible cure. The authors present a case of an extensive upper cervical chordoma treated by en bloc resection, reconstruction, and long-segment stabilization. Total spondylectomy of C2–4 with sacrifice of the right C2–4 nerve roots and a segment of the right vertebral artery was performed. The inherent anatomical complexities of en bloc resection in the upper cervical spine are discussed. To the authors' knowledge, this represents the first report of an en bloc resection for multilevel cervical chordoma.

scholarly journals A Case of C5 Vertebral Chordoma in a 73-Year-Old Patient with More Than 8 Years of Follow-Up after Total Piecemeal Spondylectomy

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Keigo Tanaka ◽  
Harutoshi Sakakima ◽  
Kazutoshi Hida ◽  
Kanako Hatanaka ◽  
Kosei Ijiri
Keyword(s):  
Cervical Spine ◽  
Malignant Tumors ◽  
Neurological Status ◽  
En Bloc Resection ◽  
En Bloc ◽  
Aged Patients ◽  
Ki 67 ◽  
Initial Surgery ◽  
Bloc Spondylectomy ◽  
Cervical Chordoma

Chordoma arising from the cervical spine is rare and the traditional long-term prognosis is typically poor. Total en bloc spondylectomy with a wide margin is generally accepted to be the most appropriate management for thoracic and lumbar malignant tumors. However, this method is still challenging for the cervical spine because of the proximity of the tumor to the vertebral arteries and neural elements. Here, we report a 73-year-old man with a C5 vertebral chordoma treated with total piecemeal spondylectomy. Histological examination revealed pathognomonic physaliphorous cells with mucus-filled cytoplasm in the tumor, and the ratio of Ki-67-positive cells within the tumor was high (19.0%), showing active proliferation rate. Local recurrences were found at 9 months, 4 years and 2 months, and 6 years after the initial surgery. All the recurrences were encapsulated and isolated and treated with an additional en bloc resection successfully at each stage. Eight years after the initial total piecemeal spondylectomy, the patient maintained his intact neurological status without local recurrence or metastasis. The prognosis of cervical chordoma depends on the patient’s age, surgical procedures, and histological features. In this report, we present that piecemeal spondylectomy is an alternative management for aged patients with cervical chordoma, even for those with high MIB-1 index.

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