Abstract
Background
Resection of sacral chordoma remains challenging because complex anatomy and important nerves in the sacrum make it difficult to achieve wide surgical margins. Computer-assisted navigation has shown promise in aiding in optimal preoperative planning and in providing accurate and precise tumour resection during surgery.
Purpose
To evaluate the benefit of using computer-assisted navigation in precise resection of sacral chordoma.
Methods
From 2007 to 2012, we performed sacral chordoma resections with computer-assisted navigation in 19 consecutive patients, of which 15 were primary and 4 were recurrent. There were 11 male and 8 female patients with a mean age of 53.5 years (range, 36–81 years). Eighteen lesions had their upper extent above S3 and the remaining one was below S3. Reconstructed three-dimensional images were used to plan the bone resection before operation. Five patients were treated with CT-based navigation system. 14 cases got ISO-C scanned during operation and CT and MR images were fused using the navigation software.
Results
The mean intra-operative blood loss was 2821 mL and the mean operating time was 300 minutes. The mean deviation of registration during operation was 1.5 mm. Wide margins and marginal margins proved by specimen evaluation were achieved in 3 patients and 14 patients, respectively. Two patients received extensive curettage followed by post-operative radiation. With mean 25.1 (range, 7–60) months of follow-up, the overall local recurrence rate was 10.5% (2/19). No recurrence was observed in 15 primary patients treated with wide or marginal margins. A second local recurrence occurred in 2 out of 4 recurrent patients. One was treated with extensive curettage and the other with marginal margin resection.
Conclusion
Computer-assisted navigation allows precise execution of intended tumour resection and therefore may improve the local control of sacral chordoma. Comparative clinical studies with long-term follow-up are necessary to confirm this benefit.
