Jeffrey A Zuccato1, Christopher D Witiw1, Julia Keith2, Erin Dyer1, Arjun Saghal3, Leodante da Costa1. 1. 1Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada. 2. 2Department of Anatomic Pathology, Neuropathology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada. 3. 3Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada.
Abstract
INTRODUCTION: Pre-operative biopsy and diagnosis of chordomas of the mobile spine is indicated as en bloc resections improve outcomes. This review of the management of mobile spine chordomas includes two cases of unexpected mobile spine chordomas where a preoperative tissue diagnosis was decided against and may have altered surgical decision-making. CASE PRESENTATION: Two lumbar spine chordomas thought to be metastatic and primary bony lesions preoperatively were not biopsied before surgery and eventual pathology revealed chordoma. Preoperative diagnoses were questioned during surgery after an intraoperative tissue diagnosis of chordoma in one case and unclear pathology with non-characteristic tumor morphology in the other. The surgical plan was altered in these cases to maximize resection as en bloc resection reduces the risk of local recurrence in chordoma. DISCUSSION: Mobile spine chordomas are rare and en bloc resection is recommended, contrary to the usual approach to more common spine tumors. Since en bloc resection of spine chordomas improves disease free survival, it has been recommended that tissue diagnosis be obtained preoperatively when chordoma is considered in the differential diagnosis, in order to guide surgical planning. We present two cases where a preoperative biopsy was considered but not obtained after neuroradiology consultation and imaging review, which may have been managed differently if the diagnosis of spine chordomas were known pre-operatively.
INTRODUCTION: Pre-operative biopsy and diagnosis of chordomas of the mobile spine is indicated as en bloc resections improve outcomes. This review of the management of mobile spine chordomas includes two cases of unexpected mobile spine chordomas where a preoperative tissue diagnosis was decided against and may have altered surgical decision-making. CASE PRESENTATION: Two lumbar spine chordomas thought to be metastatic and primary bony lesions preoperatively were not biopsied before surgery and eventual pathology revealed chordoma. Preoperative diagnoses were questioned during surgery after an intraoperative tissue diagnosis of chordoma in one case and unclear pathology with non-characteristic tumor morphology in the other. The surgical plan was altered in these cases to maximize resection as en bloc resection reduces the risk of local recurrence in chordoma. DISCUSSION: Mobile spine chordomas are rare and en bloc resection is recommended, contrary to the usual approach to more common spine tumors. Since en bloc resection of spine chordomas improves disease free survival, it has been recommended that tissue diagnosis be obtained preoperatively when chordoma is considered in the differential diagnosis, in order to guide surgical planning. We present two cases where a preoperative biopsy was considered but not obtained after neuroradiology consultation and imaging review, which may have been managed differently if the diagnosis of spine chordomas were known pre-operatively.
Authors: Ziya L Gokaslan; Patricia L Zadnik; Daniel M Sciubba; Niccole Germscheid; C Rory Goodwin; Jean-Paul Wolinsky; Chetan Bettegowda; Mari L Groves; Alessandro Luzzati; Laurence D Rhines; Charles G Fisher; Peter Pal Varga; Mark B Dekutoski; Michelle J Clarke; Michael G Fehlings; Nasir A Quraishi; Dean Chou; Jeremy J Reynolds; Richard P Williams; Norio Kawahara; Stefano Boriani Journal: J Neurosurg Spine Date: 2015-12-18