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Image-guided resection of aggressive sacral tumors

机译：影像学指导切除性aggressive骨肿瘤

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OBJECTIVE The aim of this study was to identify and discuss operative nuances utilizing image guidance in the surgical management of aggressive sacral tumors. METHODS The authors report on their single-institution, multi-surgeon, retrospective case series involving patients with pathology-proven aggressive sacral tumors treated between 2009 and 2016. They also reviewed the literature to identify articles related to aggressive sacral tumors, their diagnosis, and their surgical treatment and discuss the results together with their own experience. Information, including background, imaging, treatment, and surgical pearls, is organized by tumor type. RESULTS Review of the institutional records identified 6 patients with sacral tumors who underwent surgery between 2009 and 2016. All 6 patients were treated with image-guided surgery using cone-beam CT technology (O-arm). The surgical technique used is described in detail, and 2 illustrative cases are presented. From the literature, the authors compiled information about chordomas, chondrosarcomas, giant cell tumors, and osteosarcomas and organized it by tumor type, providing a detailed discussion of background, imaging, and treatment as well as surgical pearls for each tumor type. CONCLUSIONS Aggressive sacral tumors can be an extremely difficult challenge for both the patient and the treating physician. The selected surgical intervention varies depending on the type of tumor, size, and location. Surgery can have profound risks including neural compression, lumbopelvic instability, and suboptimal oncological resection. Focusing on the operative nuances for each type can help prevent many of these complications. Anecdotal evidence is provided that utilization of image-guided surgery to aid in tumor resection at our institution has helped reduce blood loss and the local recurrence rate while preserving function in both malignant and aggressive benign tumors affecting the sacrum.
机译：目的本研究的目的是在影像学指导下对guidance骨侵袭性肿瘤的手术治疗进行鉴别和讨论。方法作者报告了他们的单机构，多手术，回顾性病例系列，涉及2009年至2016年间经病理证实的侵袭性aggressive骨肿瘤患者。他们的手术治疗，并结合自己的经验讨论结果。信息包括背景，影像学，治疗方法和手术珍珠，均按肿瘤类型进行组织。结果回顾机构记录，确定6例于2009年至2016年间接受手术的surgery骨肿瘤患者。所有6例患者均接受了采用锥形束CT技术（O型臂）的图像引导手术治疗。详细介绍了所使用的手术技术，并介绍了2个示例性案例。从文献中，作者汇编了有关脊索瘤，软骨肉瘤，巨细胞瘤和骨肉瘤的信息，并按肿瘤类型进行组织，对每种肿瘤类型的背景，影像学和治疗方法以及手术珍珠进行了详细讨论。结论骨恶性肿瘤对于患者和治疗医师而言都是极其困难的挑战。所选的外科手术方法取决于肿瘤的类型，大小和位置。手术可能具有深远的风险，包括神经压迫，腰椎不稳和肿瘤切除不理想。专注于每种类型的手术细微差别可以帮助预防许多此类并发症。提供的轶事证据表明，在我们机构中利用图像引导手术来辅助切除肿瘤有助于减少失血量和局部复发率，同时保留影响affecting骨的恶性和侵袭性良性肿瘤的功能。

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