Patient-Specific Three-Dimensional Model for a Safe Surgical Pathwayin Sacral Chondrosarcoma

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Öztürk A. M. , Özer M. A. , Süer O. , Derin O., Gökmen F. , Keçeçi B., ...More

INDIAN JOURNAL OF SURGICAL ONCOLOGY, vol.10, no.1, pp.107-114, 2019 (Journal Indexed in ESCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 10 Issue: 1
  • Publication Date: 2019
  • Doi Number: 10.1007/s13193-018-0851-6
  • Page Numbers: pp.107-114


Sacral tumors are amongst the most challenging procedures to treat because of the complex anatomy. This study determined

whether patient-specific models change preoperative planning decisions made in preparation for en bloc resection of complex

sacral mass surgical procedures. Imaging showed a big encapsulated mass at the S2–3 level involving the neural foramina and

obscuring the nerve roots. High-resolution images were acquired and utilized to generate a patient-specific 3D tumor model. The

visual and tactile inspection of 3D models allowed the best anatomical understanding, with faster and clearer comprehension of

the surgical anatomy. The 3D sacral model was for observation of previously unapparent anatomical details; with this new

technology, surgeon can observe their planned surgical intervention, explore the patient-specific anatomy and extension of the

tumor, and sharpen their procedure choices. Moreover, multiple planes showed how far the angles on the plane would extend for

osteotomy of the sacrum. Another result was identifying correct guides and safe venture landmarks. The study helped to establish

safe osteotomy line wherever the nerve roots were retained and enabled osteotomy by preserving bilaterally the S1 and S2 nerve

roots for wide excision of wide excision of primary sacral tumor to get adequate bowel and bladder functions. Finally, it helped to

determine whether or not the remaining bone in the sacrum is sufficient for spinopelvic stability and needed fixation. It was

decided spinopelvic fixation was not necessary for this case. Surgical intervention of sacral tumors varies depending on the

tumor, its size, extension, and location. Surgery can have profound risks including unnecessary nerve root resection spinopelvic

instability and suboptimal oncological resection. 3D models help to transfer complex anatomical information to clinicians and

provide guidance in the preoperative planning stage, for intraoperative navigation and for surgical training purposes.