Image-Guided, Endoscopic Transcervical Resection of Cervical Chordoma

Hsu, Wesley; Kotowski, Thomas; Zaidi, Hasan A.; Gokaslan, Ziya L.; Wolinsky, Jean-Paul

doi:10.1055/s-2009-1242355

Cited by 5 publications

(7 citation statements)

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“…They also showed that there was no need for prolonged intubation or gastrostomy with an average hospitalization of 9 days and resolution or improvement of pain and/or neurologic deficits at final follow-up. Hsu et al [6] described a case report of a 65-year-old with a recurrent chordoma of the upper cervical spine after previous combined anterior and posterior surgeries who underwent image-guided endoscopic anterior transcervical approach for tumor resection. The patient was discharged home on postoperative day 3 without any additional neurological deficits or evidence of cerebrospinal fluid leak.…”

Section: Discussionmentioning

confidence: 99%

“…The extraoral approach involves prevascular or retrovascular retropharyngeal dissection [3,8,18], submandibular gland resection [20], or anterior transcervical retropharyngeal dissections [1,6]. The advantages of an anterior open extraoral approach include straight-forward preoperative planning, avoidance of contaminated operative fields, and shorter postoperative recovery periods.…”

Section: Introductionmentioning

confidence: 99%

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Anterior endoscopically assisted transcervical reconstruction of the upper cervical spine

Wang

Deng

et al. 2011

Eur Spine J

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Anterior decompression and/or reconstruction can be an effective method for the surgical treatment of ventral spinal cord compression in the upper cervical spine. Options for traditional surgical approaches include transoral, transnasal, and extraoral. The risk and complex anatomy with the aforementioned approaches induces surgeons to use the transcervical route to expose the upper cervical spine. A traditional transcervical approach, however, carries the disadvantages of a deep operative field and steep trajectory. We performed a new endoscopically assisted method of anterior reconstruction for the treatment of ventral lesions in upper cervical spine. Six patients were treated from

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anterior endoscopically assisted transcervical reconstruction of the upper cervical spine

Wang

Deng

et al. 2011

Eur Spine J

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“…23 The O-arm has also been used in minimally invasive spine surgery 1,3 including endoscopic surgery for resection of chordomas 8 and intraoperative CT-navigated lateral interbody fusion procedures. 4 Its role in the cervical spine, however, has been limited, both for anterior cervical surgery and posterior cervical fusion.…”

Section: Discussionmentioning

confidence: 99%

“…Hsu et al 8 described the use of an image-guided, endoscopic, transcervical approach for resection of a recurrent chordoma at C1-2. They used the BrainLAB frameless stereotactic system to remove bone, tumor, and methylmethacrylate from a previous reconstruction.…”

Section: Chordoma Resection Using Image Guidancementioning

confidence: 99%

The use of intraoperative navigation for complex upper cervical spine surgery

Guppy

Chakrabarti²,

Banerjee³

2014

FOC

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Imaging guidance using intraoperative CT (O-arm surgical imaging system) combined with a navigation system has been shown to increase accuracy in the placement of spinal instrumentation. The authors describe 4 complex upper cervical spine cases in which the O-arm combined with the StealthStation surgical navigation system was used to accurately place occipital screws, C-1 screws anteriorly and posteriorly, C-2 lateral mass screws, and pedicle screws in C-6. This combination was also used to navigate through complex bony anatomy altered by tumor growth and bony overgrowth. The 4 cases presented are: 1) a developmental deformity case in which the C-1 lateral mass was in the center of the cervical canal causing cord compression; 2) a case of odontoid compression of the spinal cord requiring an odontoidectomy in a patient with cerebral palsy; 3) a case of an en bloc resection of a C2–3 chordoma with instrumentation from the occiput to C-6 and placement of C-1 lateral mass screws anteriorly and posteriorly; and 4) a case of repeat surgery for a non-union at C1–2 with distortion of the anatomy and overgrowth of the bony structure at C-2.

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“…20,40 An extraoral prevascular approach can provide an even wider angle of approach to the periclival and subaxial area in comparison with the transoral approach, as described by Agrawal et al in a cadaveric study.…”

mentioning

confidence: 99%

Experience with intraoperative navigation and imaging during endoscopic transnasal spinal approaches to the foramen magnum and odontoid

Choudhri¹,

Mindea²,

Feroze³

et al. 2014

FOC

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Object In this study the authors share their experience using intraoperative spinal navigation and imaging for endoscopic transnasal approaches to the odontoid in 5 patients undergoing C1–2 surgery for basilar invagination at Stanford Hospital and Clinics from 2010 to 2013. Methods Of these 5 patients undergoing C1–2 surgery for basilar invagination, 4 underwent a 2-tiered anterior C1–2 resection with posterior occipitocervical fusion during a first stage surgery, followed by endoscopic endonasal odontoidectomy in a separate setting. Intraoperative stereotactic navigation was performed using a surgical navigation system in all cases. Navigation accuracy, characterized as target registration error, ranged between 0.8 mm and 2 mm, with an average of 1.2 mm. Intraoperative imaging using a CT scanner was also performed in 2 patients. Results Endoscopic decompression of the brainstem was achieved in all patients, and no intraoperative complications were encountered. All patients were extubated within 24 hours after surgery and were able to swallow within 48 hours. After appropriate initial reconstruction of the defect at the craniocervical junction, no postoperative CSF leakage, arterial injury, or need for reoperation was encountered; 1 patient developed mild postoperative velopharyngeal insufficiency that resolved by the 6-month follow-up evaluation. There were no deaths and no patients required tracheostomy placement. The average inpatient stay after surgery varied between 72 and 96 hours, without extended intensive care unit stays for any patient. Conclusions Technologies such as intraoperative CT scanning and merged MRI/CT can provide the surgeon with detailed, virtual real-time information about the extent of complex endoscopic vertebral segment resection and brainstem decompression and lessens the prospect of revision or secondary procedures in this challenging surgical corridor. Moreover, patients experience limited morbidity and can tolerate early oral intake after transnasal endoscopic odontoidectomy. Essential to the successful undertaking of these endoscopic adventures is 1) an understanding of the endoscopic nasal, skull base, and neurovascular anatomy; 2) advanced and extended-length instrumentation including navigation; and 3) a team approach between experienced rhinologists and spine surgeons comfortable with endoscopic skull base techniques

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Image-Guided, Endoscopic Transcervical Resection of Cervical Chordoma

Cited by 5 publications

References 0 publications

Anterior endoscopically assisted transcervical reconstruction of the upper cervical spine

Anterior endoscopically assisted transcervical reconstruction of the upper cervical spine

The use of intraoperative navigation for complex upper cervical spine surgery

Experience with intraoperative navigation and imaging during endoscopic transnasal spinal approaches to the foramen magnum and odontoid

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