En bloc resection of a thoracic chordoma is possible using minimally invasive anterior access: An 8-year follow-up

Goomany, Anand; Timothy, Jake; Robson, Craig; Rao, Abhay

doi:10.4103/0976-3147.172171

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…Generally, chordomas are commonly immunoreactive for AE1/AE3, EMA. [1–3,20–29] A histological examination of our case was positive for AE1/AE3, EMA, Vimentin indicating chordoma from epithelial cells, which confirmed the diagnosis of thoracic chordoma.…”

Section: Discussionsupporting

confidence: 73%

Surgical treatment of giant chordoma in the thoracic spine combining thoracoscopic and posterior spinal surgery

et al. 2019

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Rationale:Giant thoracic chordoma is a highly unusual disease with no standard curative managements yet. The objective of this study is to report a very rare case of giant thoracic chordoma successfully operated by combination of thoracoscopic surgery together with posterior spinal surgery. The management of these unique cases has yet to be well-documented.Patient concerns:A 64-year-old man presented with a 4-month history of continuous and progressive back pain. The patient, who had been diagnosed of sacral chordoma for 2 years, received surgical treatment of posterior sacral tumor resection and instrumentation. A lytic, expanding lesion of the T5 and T6 vertebral and paraspinal region with mild epidural spinal cord compression was identified.Diagnosis:MRI of spine and PET/CT showed spinal cord compression secondary to the epidural component of the T5 and T6 mass, with increased metastatic marrow infiltration of the left T5 and T6 vertebral and paravertebral region, which presented as a solid tumor. Postoperative pathology confirmed the diagnosis of thoracic chordoma.Interventions:The patient underwent 1-stage thoracoscopic release of vertebral and paravertebral tumors, posterior resection of T5-T6 vertebral and paravertebral tumors, T4-T7 spinal canal decompression, and T2-T9 pedicle screw fixation procedure via a posterior approach.Outcomes:The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 3-month and 6-month follow-up visit. There were no other complications associated with the operation during the follow-up period.Lessons:Taken together, the lesion's clinical features, imaging results, and pathological characteristics are unique. Combined efforts of specialists from orthopedics, thoracic surgery, neurosurgery, and medical oncology led to the successful diagnosis and management of this patient. Giant thoracic chordoma, although rare, should be part of the differential diagnosis when the patient has a history of sacral chordoma and presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the giant thoracic chordoma when the tumor has caused neurological deficits. One-stage thoracoscopic release or resection of vertebral and paravertebral tumor is also a good choice for surgical treatment.

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Section: Discussionsupporting

confidence: 73%

Surgical treatment of giant chordoma in the thoracic spine combining thoracoscopic and posterior spinal surgery

et al. 2019

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“…Thoracic chordomas are rare, slow-growing and recurring neoplasms that are prone to dissemination and sarcomatous differentiation [ 8 ]. Two publications, from 2012 and 2016, note finding ~30 reports since 1902 of thoracic spine chordomas [ 4 , 9 ]. With regard to chordomas overall, most occur in middle age with a peak during the sixth decade of life [ 4–7 ].…”

Section: Discussionmentioning

confidence: 99%

Thoracic chordoma in a 36-year-old female

Kassels

Melamed

Rogers

et al. 2022

Journal of Surgical Case Reports

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Chordomas are rare tumors that occur in the bones of the skull base and spine, affecting 1 in 1 000 000 people per year. Thoracic chordomas comprise just 1% of chordomas. A 36-year-old female underwent a right video-assisted thoracoscopic surgical resection for a cystic mass at the level of T2-3 which was well-circumscribed. Despite efforts to achieve an intact resection, there was tumor spillage due to friability, and it was taken off the bony vertebral body with no margin. The final pathologic diagnosis was chordoma. Thoracic chordomas are rare, slow-growing, recurring neoplasms that require proper preoperative diagnostic imaging and ideally preoperative trocar computed tomography-guided biopsy from a posterior approach if anatomic access is possible. They are prone to dissemination and sarcomatous differentiation. The surgical approaches for reported thoracic chordoma tumors vary due to their rarity and the variation in tumor location and presentation.

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confidence: 99%

“…2,3,[7][8][9][10] En bloc resection is technically demanding, but substantial literature supports its use and efficacy in the mobile spine. 7,[11][12][13][14][15][16][17][18] These lesions often require a challenging anterior access through the thoracic or peritoneal cavities and can lead to significant spinal destabilization requiring innovative approaches to reconstruction, stabilization, and fusion. Adaptations to improve the feasibility of en bloc resection have included multistaged surgeries, collaboration across surgical specialties, minimally invasive techniques, and image-guided navigation.…”

mentioning

confidence: 99%

“…Adaptations to improve the feasibility of en bloc resection have included multistaged surgeries, collaboration across surgical specialties, minimally invasive techniques, and image-guided navigation. 11,12,15,17,[19][20][21] Through this case, we describe the multidisciplinary surgical management of a large cervicothoracic chordoma in which intraoperative utilization of computed tomography (CT)-guided navigation and patientspecific three-dimensional (3D)-printed tumor modeling aided a successful 2-stage en bloc tumor resection and spinal reconstruction.…”

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confidence: 99%

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A modern multidisciplinary approach to a large cervicothoracic chordoma using staged en bloc resection with intraoperative image-guided navigation and 3D-printed modeling: illustrative case

Pertsch

Leary

Camara-Quintana

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUNDCervicothoracic junction chordomas are uncommon primary spinal tumors optimally treated with en bloc resection. Although en bloc resection is the gold standard for treatment of mobile spinal chordoma, tumor location, size, and extent of involvement frequently complicate the achievement of negative margins. In particular, chordoma involving the thoracic region can require a challenging anterior access, and en bloc resection can lead to a highly destabilized spine.OBSERVATIONSModern technological advances make en bloc resection more technically feasible than ever before. In this case, the successful en bloc resection of a particularly complex cervicothoracic junction chordoma was facilitated by a multidisciplinary surgical approach that maximized the use of intraoperative computed tomography–guided spinal navigation and patient-specific three-dimensional–printed modeling.LESSONSThe authors review the surgical planning and specific techniques that facilitated the successful en bloc resection of this right-sided chordoma via image-guided parasagittal osteotomy across 2 stages. The integration of emerging visualization technologies into complex spinal column tumor management may help to provide optimal oncological care for patients with challenging primary tumors of the mobile spine.

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En bloc resection of a thoracic chordoma is possible using minimally invasive anterior access: An 8-year follow-up

Cited by 5 publications

References 6 publications

Surgical treatment of giant chordoma in the thoracic spine combining thoracoscopic and posterior spinal surgery

Surgical treatment of giant chordoma in the thoracic spine combining thoracoscopic and posterior spinal surgery

Thoracic chordoma in a 36-year-old female

A modern multidisciplinary approach to a large cervicothoracic chordoma using staged en bloc resection with intraoperative image-guided navigation and 3D-printed modeling: illustrative case

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