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Dini LI, Dini SA, Dias WWDS, Guarenti MM, Lombardo EM, Pagnoncelli RM, Isolan GR. Anatomical aspects and technical note of a modified retropharyngeal approach and reconstruction of the anterior occipitocervical junction. Br J Neurosurg 2022:1-6. [PMID: 35708248 DOI: 10.1080/02688697.2022.2086966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/21/2022] [Accepted: 06/03/2022] [Indexed: 11/02/2022]
Abstract
Surgery to expose the anterior occiptocervical junction (OCJ) is exacting, and optimal approaches are debatable. The close proximity of vital structures and difficult surgical access present a unique challenge to treat lesions in this area. Routine access to the upper anterior cervical spine remains limited. The authors present a modified retropharyngeal approach and instrumentation in order to resect an exceptionally rare atypical rhabdoid teratoid tumor involving the craniovertebral junction. The technical aspects of this approach in anatomical perspectives are discussed in this article.
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Affiliation(s)
- Leandro Infantini Dini
- Advanced Center of Neurology and Neurosurgery (CEANNE), Grupo Hospitalar Conceicao, Porto Alegre, Brazil
- Department of Neurosurgery, Hospital Unimed Vale do Sinos, Novo Hamburgo, Brazil
- Department of Neurosurgery, Grupo Hospitalar Conceição (GHC), Porto Alegre, Brazil
| | - Simone Afonso Dini
- Department of Radiology, Hospital Unimed Vale do Sinos, Novo Hamburgo, Brazil
| | | | - Michel Martins Guarenti
- Department of Oral and Maxillofacial Surgery, Grupo Hospitalar Conceição (GHC), Porto Alegre, Brazil
| | - Eduardo Madruga Lombardo
- Department of Oral and Maxillofacial Surgery, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Rogério Miranda Pagnoncelli
- Department of Oral and Maxillofacial Surgery, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Gustavo Rassier Isolan
- Advanced Center of Neurology and Neurosurgery (CEANNE), Grupo Hospitalar Conceicao, Porto Alegre, Brazil
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3
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Obid P, Fekete T, Drees P, Haschtmann D, Kleinstück F, Loibl M, Jeszenszky D. Revision surgery for incomplete resection or recurrence of cervical spine chordoma: a consecutive case series of 24 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2915-2924. [PMID: 34338872 DOI: 10.1007/s00586-021-06946-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/25/2021] [Accepted: 07/23/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Chordomas are rare tumors with an annual incidence of approximately one per million. Chordomas rarely metastasize but show a high local recurrence rate. Therefore, these patients present a major clinical challenge, and there is a paucity of the literature regarding the outcome after revision surgery of cervical spine chordomas. Available studies suggest a significantly worse outcome in revision scenarios. The purpose of this study is to analyze the survival rate, and complications of patients that underwent revision surgery for local recurrence or incomplete resection of chordoma at the craniocervical junction or at the cervical spine. METHODS 24 consecutive patients that underwent revision surgery for cervical spine chordoma remnants or recurrence at a single center were reviewed retrospectively. We analyzed patient-specific surgical treatment strategies, complications, and outcome. Kaplan-Meier estimator was used to analyze five-year overall survival. RESULTS Gross total resection was achieved in 17 cases. Seven patients developed dehiscence of the pharyngeal wall, being the most common long-term complication. No instability was observed. Postoperatively, four patients received proton beam radiotherapy and 12 patients had combined photon and proton beam radiotherapy. The five-year overall survival rate was 72.6%. CONCLUSION With thorough preoperative planning, appropriate surgical techniques, and the addition of adjuvant radiotherapy, results similar to those in primary surgery can be achieved.
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Affiliation(s)
- Peter Obid
- Department of Spine Surgery, Schulthess Klinik, Zürich, Switzerland.
- Department of Orthopaedics and Orthopaedic Surgery, Greifswald University Hospital, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany.
| | - Tamás Fekete
- Department of Spine Surgery, Schulthess Klinik, Zürich, Switzerland
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, Mainz University Hospital, Mainz, Germany
| | | | - Frank Kleinstück
- Department of Spine Surgery, Schulthess Klinik, Zürich, Switzerland
| | - Markus Loibl
- Department of Spine Surgery, Schulthess Klinik, Zürich, Switzerland
| | - Dezsö Jeszenszky
- Department of Spine Surgery, Schulthess Klinik, Zürich, Switzerland
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Akinduro OO, Garcia DP, Domingo RA, Vivas-Buitrago T, Sousa-Pinto B, Bydon M, Clarke MJ, Gokaslan ZL, Kalani MA, Abode-Iyamah K, Quiñones-Hinojosa A. Cervical chordomas: multicenter case series and meta-analysis. J Neurooncol 2021; 153:65-77. [PMID: 33811630 DOI: 10.1007/s11060-021-03742-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND En bloc spondylectomy is the gold standard for surgical resection of sacral chordomas (CHO), but the effect of extent of resection on recurrence and survival in patients with CHO of the cervical spine remains elusive. METHODS MEDLINE, Embase, Scopus, and Cochrane were systematically reviewed. Patients with cervical CHO treated at three tertiary-care academic institutions were reviewed for inclusion. We performed an individual participant data meta-analysis to assess the overall survival (OS) and progression free survival (PFS) after en bloc-gross total resection (GTR) and intralesional-GTR compared to subtotal resection (STR). We then performed an intention-to-treat analysis including all patients with attempted en bloc resection in the en bloc group, regardless of the surgical margins. RESULTS There was a total of 13 series including 161 patients with cervical CHO, including our current series of 22 patients. GTR (en bloc-GTR + intralesional-GTR) was associated with a significant decrease in the risk of local progression (pooled hazard ratio (PHR) = 0.22; 95% CI 0.08-0.59; p = 0.003) and risk of death (PHR 0.31; 95%; CI 0.12-0.83; p = 0.020). A meta-regression analyses determined that intralesional-GTR improved PFS (PHR 0.35; 95% CI 0.16-0.76; p = 0.009) as well as OS (PHR 0.25; 95% CI 0.08-0.79; p = 0.019) when compared to STR. En bloc-GTR was associated with a significant reduction in the risk of local progression (PHR 0.06; 95% CI 0.01-0.77; p = 0.030), but not a decreased OS (PHR 0.50; 95% CI 0.19-1.27; p = 0.145). Our intention-to-treat analyses revealed a near significant improvement in OS for the en bloc group (PHR: 0.15; 95% CI 0.02-1.22; p = 0.054), and nearly identical improvement in PFS. Radiation data was not available for the studies included in the meta-analysis. CONCLUSION This is the first and only meta-analysis of patients with cervical CHO. We found that both en bloc-GTR and intralesional-GTR resulted in improved local tumor control when compared to STR.
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Affiliation(s)
| | - Diogo P Garcia
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | - Alfredo Quiñones-Hinojosa
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA.
- Brain Tumor Stem Cell Laboratory, Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd. S, Jacksonville, FL, 32224, USA.
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7
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Bian C, Chen N, Li XL, Zhou XG, Lin H, Jiang LB, Liu WM, Chen Q, Dong J. Surgery Combined with Radiotherapy to Treat Spinal Tumors: A Review of Published Reports. Orthop Surg 2017; 8:97-104. [PMID: 27384717 DOI: 10.1111/os.12230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/07/2016] [Indexed: 12/11/2022] Open
Abstract
Spinal tumors result in high morbidity and a high rate of lower limb paralysis. Both surgical therapy and radiation therapy (RT) are used to treat spinal tumors; however, how best to combine these two therapies to maximize the benefits and minimize the risks is still being debated. It is also difficult to decide the optimal timing, course and dose of RT, especially in pregnant women and children. The aim of this review is to assist surgeons who are dealing with spinal tumors by providing comprehensive information about advanced techniques for administering RT with greater precision and safety, and about the impact of various ways of combining surgery and RT on therapeutic outcomes. We here review published reports about treating spinal tumors with a combination of these two forms of therapy and attempt to draw appropriate conclusions concerning selection of optimal treatment protocols. Our conclusion is that postoperative radiotherapy, especially with high-precision, low-dose and multiple fractions, and brachytherapy are promising therapies to combined with surgery.
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Affiliation(s)
- Chong Bian
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nong Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai, China
| | - Xi-Lei Li
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Gang Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Bo Jiang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wang-Mi Liu
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qian Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Meng T, Yin H, Li B, Li Z, Xu W, Zhou W, Cheng M, Wang J, Zhou L, Yang X, Liu T, Yan W, Song D, Xiao J. Clinical features and prognostic factors of patients with chordoma in the spine: a retrospective analysis of 153 patients in a single center. Neuro Oncol 2014; 17:725-32. [PMID: 25488908 DOI: 10.1093/neuonc/nou331] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 09/15/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chordoma in the spine is relatively rare, and minimal information has been published in the literature regarding this subject. Moreover, there are controversies over prognostic factors of this disease. METHODS A retrospective analysis of chordoma in the spine was performed by survival analysis. Local relapse-free survival (LRFS) and overall survival (OS) were analyzed from the date of surgery to the date of local recurrence and death. The LRFS and OS rates were estimated using the Kaplan-Meier method to identify potential prognostic factors. Factors with P values ≤ .1 were subjected to multivariate analysis by Cox regression analysis. P values ≤ .05 were considered statistically significant. RESULTS A total of 153 patients with spinal chordoma were included in the study. The mean follow-up period was 72.0 months (range, 1-279 months). Local recurrence was detected in 51 cases after initial surgery in our center, while death occurred in 42 cases. The statistical analysis suggested that tumor location of C3-L5, dedifferentiated chordoma, preoperative Frankel scores A-C, and total spondylectomy were independent prognostic factors for LRFS. In addition, total en bloc spondylectomy and Karnofsky' performance status (KPS) ≥ 80% were favorable factors for OS. CONCLUSIONS Total spondylectomy, by either en bloc or piecemeal method, could significantly reduce LRFS for spinal chordoma. Location of C3-L5 is a favorable factor for LRFS, while dedifferentiated subtype and preoperative Frankel scores A-C are adverse prognostic factors. In addition, total en bloc spondylectomy and KPS ≥ 80% significantly improve overall survival of patients with spinal chordoma.
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Affiliation(s)
- Tong Meng
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
| | - Huabin Yin
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
| | - Bo Li
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
| | - Zhenxi Li
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
| | - Wei Xu
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
| | - Wang Zhou
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
| | - Mo Cheng
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
| | - Jing Wang
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
| | - Lei Zhou
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
| | - Xinghai Yang
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
| | - Tielong Liu
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
| | - Wangjun Yan
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
| | - Dianwen Song
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
| | - Jianru Xiao
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.)
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