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60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Spinal chordoma: first experiences of combined surgical and spinal radiosurgical treatment with refined intra- and perioperative imaging

Meeting Abstract

  • S. Zausinger - Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • A. Muacevic - Europäisches CyberKnife Zentrum München-Großhadern
  • B. Wowra - Europäisches CyberKnife Zentrum München-Großhadern
  • G. Poepperl - Klinik für Nuklearmedizin, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • J.-C. Tonn - Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP08-09

DOI: 10.3205/09dgnc337, URN: urn:nbn:de:0183-09dgnc3375

Veröffentlicht: 20. Mai 2009

© 2009 Zausinger et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: In most cases, spinal chordomas are sacrally located neoplasms arising from rests of notochordal tissue; sacrectomy with consecutive severe deficits is mostly advocated. We analyzed a pilot series with combined treatment by microsurgery and spinal robotic radiosurgery. The benefit of pre- and postoperative PET/CT-imaging and intraoperative CT-imaging (iCT) in combination with neuronavigation was evaluated.

Methods: Five patients (4 sacral, one cervical chordoma; diseased since 52±38 mo) were operated ten times since 1/07. No patient had severe neurological deficits. ICT was performed to control resection, to exclude lesions of adjacent structures and, in 2 patients, to generate images for navigation. In 4 patients remnant tumor with high operative risk was treated by spinal robotic radiosurgery for altogether 13 times (CyberKnife, Accuray; USA). In 3 patients FDG PET/CT was performed.

Results: Four patients are stable up to now without new deficits; one patient (tumor since 3/06, now progressive with imatinib chemotherapy) developed slight bladder disturbance since the initial removal of a bulky tumor S 3–5. All tumors could be identified by iCT with contrast; image acquisition was rapid (15±5 min) to perform, and anatomic and fluoroscopic validation showed sufficient accuracy of navigation of sacral, gluteal, and tumors located near to the retroperitoneal space. All patients tolerated radiosurgery well. Tumor volume ranged from 1.4–100.5cm³, median 17.1cm³. Tumor dose was maintained at 22–33Gy, median 28Gy at the 70% isodose line. No radiation toxicity, new deficits or growth of radiosurgically treated tumor occurred. FDG PET/CT indicated tumor recurrence/progression by increased FDG uptake in all 3 patients concordantly with the histological results. PET/CT was especially useful in cases of recurrent tumor with diffuse soft tissue scarring.

Conclusions: Combined surgical and radiosurgical treatment offers a safe and effective treatment for spinal chordomas, especially for patients with lesions not completely amenable to surgery. Combined treatment seems to offer time periods of non-recurrence and survival comparable to those of conventionally operated patients without the severe deficits after sacrectomy. Neuronavigation with iCT provided rapid and easy tumor detection, resection control, and excluded injury of adjacent organs. PET/CT offered an improved tumor/scar distinction by particularly detecting “vital” parts of the tumor, thus helping to focus recurrent surgical and radiosurgical interventions.