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Dean Chou, Frank Acosta Jr., Jordan M. Cloyd, and Christopher P. Ames

A s a malignant tumor of the spinal column, chordoma is difficult to treat because of its local aggressiveness. It has been shown that en bloc resection of chordoma with wide margins, or even marginal margins, has a significantly better rate of control than intralesional resection. 3 , 5 , 8 , 10 Spondylectomy is ideal for resection of chordoma, but this can be difficult in the cervical spine because of the nerve roots and VAs involved. Multilevel chordomas pose even more challenges. Not only are multiple levels of nerve roots and the VAs involved, but

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Benjamin D. Fox, Bartley D. Mitchell, Akash J. Patel, Katherine Relyea, Shankar P. Gopinath, Claudio Tatsui, and Bruce L. Ehni

using a modified bulb syringe that we connected to standard suction tubing to function as a vacuum retractor. This technique allows for rapid, safe, en bloc resection of large convexity meningiomas with minimal to no pressure on the surrounding brain. We present an illustrative case and then describe and discuss the technique. Case Illustration History and Examination This 82-year-old man with no significant medical history experienced new onset seizures in 2003. He was started on antiepileptic medications and MR imaging of his brain was obtained

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Michelle J. Clarke, Daniel L. Price, Harry J. Cloft, Leal G. Segura, Cindy A. Hill, Meghen B. Browning, Jon M. Brandt, Sean M. Lew, and Andrew B. Foy

O steosarcoma is an aggressive primary bone tumor with a poor overall prognosis. 23 , 37 , 39 Currently, multimodality therapy is recommended and includes adjuvant and neoadjuvant chemotherapy and surgery. 2 , 14 , 16 , 40 Based on data from studies of osteosarcoma involving the appendicular bones, 21 , 27 , 28 , 36 a survival advantage is conferred by wide-margin resections. Additionally, en bloc resection of extraspinal osteosarcoma, whereby the tumor is removed in one piece with negative margins, has been demonstrated to provide improved local

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En bloc resection of multilevel cervical chordoma with C-2 involvement

Case report and description of operative technique

Laurence D. Rhines, Daryl R. Fourney, Abdolreza Siadati, Ian Suk, and Ziya L. Gokaslan

). Occipitocervicothoracic fixation was performed using contoured titanium rods coupled with occipital wiring, C5—T1 Wisconsin spinous process wiring, and T2–9 pedicle screw fixation ( Fig. 3 ). After the first stage, an MR angiogram was performed to ensure patency of the left VA because the right VA would be sacrificed during the second stage of the operation. The goals of the second (anterior) stage were to complete the en bloc resection of the tumor and reconstruct and stabilize the ventral spinal defect. The patient was positioned supine with the left leg exposed for a possible

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Masashi Komagata, Makoto Nishiyama, Atshuhiro Imakiire, and Hirobumi Kato

devised a new surgical technique allowing for the practical en bloc resection of primary lung cancer invading the chest wall and spinal column. In the present case we describe the successful outcome after surgery involving a combination of surgical procedures and induction therapy. Case Report History This 42-year-old man, a radiation oncology technician, had a 22-year history of smoking (20 cigarettes/day). In June 1999, the patient experienced numbness on the ulnar side of the right upper arm. Radiography of the chest demonstrated a Pancoast tumor

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Kern H. Guppy, Indro Chakrabarti, Richard S. Isaacs, and Jae H. Jun

C hordomas are rare, low-grade, primary malignant bone tumors that originate in remnants of the primitive notochord of the axial skeleton. They are slow growing and demonstrate aggressive local recurrence with a low tendency to metastasis. The tumor is resistant to conventional radiotherapy, and photon radiotherapy offers better control. 21 , 26 Chemotherapy provides little or not benefit with respect to recurrence. 9 Surgery remains the primary treatment for this tumor, but wide margins are required. The surgical techniques of en bloc resection with

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Daryl R. Fourney, Laurence D. Rhines, Stephen J. Hentschel, John M. Skibber, Jean-Paul Wolinsky, Kristin L. Weber, Dima Suki, Gary L. Gallia, Ira Garonzik, and Ziya L. Gokaslan

reconstruction techniques restoring the continuity of the pelvic ring and spinal column integrity are necessary after total sacrectomy. 19 The purpose of this study was to review our experience with primary sacral tumors amenable to en bloc resection, paying particular attention to the functional and oncological results as well as the rate of complications. A classification of surgical approaches, based on the desire to preserve neurological function, is also presented. Clinical Material and Methods Patients were identified by a search of the database at The University

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Mauricio J. Avila, Jesse Skoch, Vernard S. Fennell, Sheri K. Palejwala, Christina M. Walter, Samuel Kim, and Ali A. Baaj

incisional biopsy is performed, 3 , 14 the best treatment for these lesions is en bloc resection. 3 , 4 , 6 , 7 , 10 , 14 The best disease-free prognostic factor is negative margins at the surgical site. 2 However, en bloc resection is technically challenging 10 and associated with significant potential complications. 1 Paraspinal primary bone tumors are unique since these lesions are adjacent to the vertebral column but sometimes without obvious involvement of the vertebral bodies. The best approach for these lesions is also en bloc with wide resection, but the

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Surbhi Jain, Eric Sommers, Matthias Setzer, and Frank Vrionis

surgical technique for Pancoast tumors that includes en bloc resection as well as spinal stabilization through a single-stage posterior approach without any added morbidity and describe 2 cases in which we used this technique at the H. Lee Moffitt Cancer Center. Surgical Technique Anesthesia and Positioning General anesthesia is used with a double-lumen endotracheal tube. Somatosensory evoked potential and motor evoked potential monitoring are performed throughout the surgery. The patient is positioned prone in a Jackson table with the arm on the side of the

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John F. Burke, Andrew K. Chan, Rory R. Mayer, Joseph H. Garcia, Brenton Pennicooke, Michael Mann, Sigurd H. Berven, Dean Chou, and Praveen V. Mummaneni

confirmed by pathological analysis, en bloc resection was planned. The invasion into both chest cavities and the mediastinum made removing the chordoma entirely from a posterior-only approach too risky for possible spinal cord damage and intralesional violation. Moreover, the upper thoracic spine poses unique access obstacles not only because of the kyphotic nature of the spine in this area, but also because the mediastinum and the innominate vein are essentially immobile. Thus, a standard median sternotomy would not have sufficed. In addition, because the tumor was in