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

Abstract

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.

Unusual Presentation of Thoracic Chordoma with Spinal Epidural Hematoma: A Rare Case Report and PRISMA-Driven Systematic Review

“…Also, the posterior approach for spinal decompression was recommended in giant chordomas with neurological deficits. 19 The present case underwent short and long-segment fixation. The short segment fixation was conducted prior to the diagnosis of chordoma.…”

A rare case of chordoma presenting as a Pancoast tumor

“…Chordomas rarely arise from the thoracic spine. While three cases of chordoma have been reported with brachial plexus involvement, [9][10][11] to the authors' knowledge this is the first case of a chordoma presenting as a Pancoast tumor. Histopathological confirmation is an essential first step which facilitates subsequent imaging for staging and planning of surgical resection.…”

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

“…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 , 19–21 …”

“…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.…”

“…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.…”