Faculty Collaboration Database

Use of Navigated Ultrasonic Bone Cutting Tool for En Bloc Resection of Thoracic Chondrosarcoma: Technical Report. Oper Neurosurg (Hagerstown) 2020 Oct 15;19(5):551-556

Date

08/04/2020

Pubmed ID

32745212

DOI

10.1093/ons/opaa239

Scopus ID

2-s2.0-85093539256 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

BACKGROUND: En bloc surgical resection with wide margins offers the best local control rates for chondrosarcoma of the spine.

OBJECTIVE: To describe the surgical technique for en bloc resection of a large thoracic chondrosarcoma using image guidance for a complex osteotomy with an ultrasonic bone cutting device (Misonix, Farmingdale, New York).

METHODS: A 2-stage procedure was performed for resection of a thoracic chondrosarcoma involving the T3-T7 vertebral bodies. During the first stage, a posterior approach, the ultrasonic bone cutter was precisely navigated to perform an intralaminar osteotomy as well as a multilevel split sagittal osteotomy through the vertebral bodies. In the second stage, a transthoracic approach was used to complete the en bloc resection of the specimen. Intraoperative frozen sections from the surgical margins were negative for tumor.

RESULTS: The ultrasonic bone cutting device was navigated based on coregistration of the intraoperative computed tomography (CT) images and preoperative magnetic resonance imaging (MRI). Real-time navigation using coregistered images enabled identification of tumor margins within the bone and adjacent soft tissue allowing precise execution of the intralaminar and multilevel split sagittal vertebral osteotomies. Surgical video demonstrates the utility of real-time navigation to properly identify the tumor margins and guide the ultrasonic bone cutting tool during the osteotomies.

CONCLUSION: We describe the use of image guidance to navigate an ultrasonic bone cutting tool for a complex en bloc resection of a multilevel thoracic spine chondrosarcoma.

Author List

Vedantam A, Vigneswaran K, Rao G, Walsh GL, Rhines LD, Tatsui CE

Author

Aditya Vedantam MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Chondrosarcoma
Humans
Osteotomy
Spinal Neoplasms
Spine
Ultrasonics