Top

Clinical Orthopaedics and Related Research®

Published in:

01-01-2012 | Clinical Research

Navigation-assisted Surgery for Bone and Soft Tissue Tumors With Bony Extension

Authors: Makoto Ieguchi, MD, Manabu Hoshi, MD, PhD, Jun Takada, MD, Noriaki Hidaka, MD, PhD, Hiroaki Nakamura, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2012

Abstract

Background

The navigation system was introduced to orthopaedic surgery in the 1990s. More recently, CT-based navigation systems have been used more commonly in spine and joint replacement surgery because of their precision.

Questions/purposes

The aim of our study was to evaluate the accuracy and efficacy of navigation-assisted excision of bone and soft tissue tumors.

Methods

From 2006 to 2009, we performed navigation-assisted surgery in 16 patients, 11 males and five females, with a mean age of 39 years (range, 13–70 years). We diagnosed nine benign bone tumors and seven malignant bone and soft tissue tumors. In two patients, the malignant soft tissue tumors infiltrated the adjacent bones. Nine excisional biopsies for benign tumors and seven en bloc excisions for malignant tumors were performed. In all cases, the point registration method was performed using 10 skin markers, which were placed around the tumor. Each excisional difference between the preoperative and postoperative plans was evaluated histologically or by postoperative CT.

Results

The mean accuracy of this system, which was determined using skin markers, was 0.93 mm (range, 0.6–1.2 mm). All biopsy and excision samples were evaluated by pathologic examination and postoperative CT imaging. The mean difference between the planned margin and postoperative CT or excised histologic specimen was 0 mm to 4 mm. The mean followup was 34 months (range, 10–54 months). There were no local recurrences, except for excision of skip metastases in a patient with a chordoma.

Conclusion

We report our experience with navigation-assisted surgery for bone and soft tissue tumors. Navigation-assisted surgery could be indicated for sufficiently reliable, accurate, and minimally invasive resections.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Amiot LP, Labelle H, DeGuise JA, Sati M, Brodeur P, Rivard CH. Computer-assisted pedicle screw fixation: a feasibility study. Spine (Phila Pa 1976). 1995;20:1208–1212.CrossRef

Araki N, Myoui A, Kuratsu S, Hashimoto N, Inoue T, Kudawara I, Ueda T, Yoshikawa H, Masaki N, Uchida A. Intraoperative extracorporeal autogenous irradiated bone grafts in tumor surgery. Clin Orthop Relat Res. 1999;368:196–206.PubMedCrossRef

Arand M, Hartwig E, Kinzl L, Gebhard F. Spinal navigation in tumor surgery of the thoracic spine: first clinical results. Clin Orthop Relat Res. 2002;399:211–218.PubMedCrossRef

Athwal GS, Pichora DR, Ellis RE, Rudan JF. A computer-assisted guidance technique for the localization and excision of osteoid osteoma. Orthopedics. 2004;27:195–197.PubMed

Berlemann U, Langlotz F, Langlotz U, Nolte LP. [Computer-assisted orthopedic surgery: from pedicle screw insertion to further applications] [in German]. Orthopade. 1997;26:463–469.PubMed

Bucholz R, Marzouk S, Levy A. In Alexander E 3rd, Maciunas RJ, eds. Advanced Neurosurgical Navigation. New York, NY: Thieme Medical Publishers; 1999:345–355.

Cho HS, Oh JH, Han I, Kim HS. Joint-preserving limb salvage surgery under navigation guidance. J Surg Oncol. 2009;100:227–232.PubMedCrossRef

Delp SL, Stulberg SD, Davies B, Picard F, Leitner F. Computer assisted knee replacement. Clin Orthop Relat Res. 1998;354:49–56.PubMedCrossRef

Dessenne V, Lavallée S, Julliard R, Orti R, Martelli S, Cinquin P. Computer-assisted knee anterior cruciate ligament reconstruction: first clinical tests. J Image Guid Surg. 1995;1:59–64.PubMedCrossRef

10.

Folpe AL, Fanburg-Smith JC, Billings SD, Bisceglia M, Bertoni F, Cho JY, Econs MJ, Inwards CY, Jan de Beur SM, Mentzel T, Montgomery E, Michal M, Miettinen M, Mills SE, Reith JD, O’Connell JX, Rosenberg AE, Rubin BP, Sweet DE, Vinh TN, Wold LE, Wehrli BM, White KE, Zaino RJ, Weiss SW. Most osteomalacia-associated mesenchymal tumors are a single histopathologic entity: an analysis of 32 cases and a comprehensive review of the literature. Am J Surg Pathol. 2004;28:1–30.PubMedCrossRef

11.

Glossop ND, Hu RW, Randle JA. Computer-aided pedicle screw placement using frameless stereotaxis. Spine (Phila Pa 1976). 1996;21:2026–2034.CrossRef

12.

Hauser R, Westermann B, Probst R. Noninvasive tracking of patient’s head movements during computer-assisted intranasal microscopic surgery. Laryngoscope. 1997;107:491–499.PubMedCrossRef

13.

Heermann R, Schwab B, Issing PR, Haupt C, Lenarz T. Navigation with the StealthStation^TM in skull base surgery: an otolaryngological perspective. Skull Base. 2001;11:277–285.PubMedCrossRef

14.

Hufner T, Kfuri M Jr, Galanski M, Bastian L, Loss M, Pohlemann T, Krettek C. New indications for computer-assisted surgery: tumor resection in the pelvis. Clin Orthop Relat Res. 2004;426:219–225.PubMedCrossRef

15.

Hufner T, Pohlemann T, Tarte S, Gänsslen A, Geerling J, Bazak N, Citak M, Nolte LP, Krettek C. Computer-assisted fracture reduction of pelvic ring fractures: an in vitro study. Clin Orthop Relat Res. 2002;399:231–239.PubMedCrossRef

16.

Jaramaz B, DiGioia AM III, Blackwell M, Nikou C. Computer assisted measurement of cup placement in total hip replacement. Clin Orthop Relat Res. 1998;354:70–81.PubMedCrossRef

17.

Kamimura M, Ebara S, Itoh H, Tateiwa Y, Kinoshita T, Takaoka K. Accurate pedicle screw insertion under the control of a computer-assisted image guiding system: laboratory test and clinical study. J Orthop Sci. 1999;4:197–206.PubMedCrossRef

18.

Kawaguchi N, Matsumoto S, Manabe J. New method of evaluating the surgical margin and safety margin for musculoskeletal sarcoma, analysed on the basis of 457 surgical cases. J Cancer Res Clin Oncol. 1995;121:555–563.PubMedCrossRef

19.

Krackow KA, Phillips MJ, Bayers-Thering M, Serpe L, Mihalko WM. Computer-assisted total knee arthroplasty: navigation in TKA. Orthopedics. 2003;26:1017–1023.PubMed

20.

Lindner NJ, Ozaki T, Roedl R, Gosheger G, Winkelmann W, Wörtler K. Percutaneous radiofrequency ablation in osteoid osteoma. J Bone Joint Surg Br. 2001;83:391–396.PubMedCrossRef

21.

Maurer CR Jr, Maciunas RJ, Fitzpatrick JM. Registration of head CT images to physical space using a weighted combination of points and surfaces. IEEE Trans Med Imaging. 1998;17:753–761.PubMedCrossRef

22.

Mitsui T, Fujii M, Tsuzaka M, Hayashi Y, Asahina Y, Wakabayashi T. Skin shift and its effect on navigation accuracy in image-guided neurosurgery. Radiol Phys Technol. 2010;4:37–42.PubMedCrossRef

23.

Moody JE, Nikou C, Picard F, Levison T, Jaramaz B, DiGioia AM 3rd, Reverte CF. Computer-integrated anterior cruciate ligament reconstruction system. J Bone Joint Surg Am. 2002;84(suppl 2):99–101.PubMed

24.

Neumann AM Jr, Pasquale-Niebles K, Bhuta T, Sillers MJ. Image-guided transnasal endoscopic surgery of the paranasal sinuses and anterior skull base. Am J Rhinol. 1999;13:449–454.PubMedCrossRef

25.

Rajasekaran S, Karthik K, Chandra VR, Rajkumar N, Dheenadhayalan J. Role of intraoperative 3D C-arm-based navigation in percutaneous excision of osteoid osteoma of long bones in children. J Pediatr Orthop B. 2010;19:195–200.PubMedCrossRef

26.

Schlöndorff G, Mösges R, Meyer-Ebrecht D, Krybus W, Adams L. [CAS (computer assisted surgery): a new procedure in head and neck surgery] [in German]. HNO. 1989;7:187–190.

27.

Shimada T, Mizutani S, Muto T, Yoneya T, Hino R, Takeda S, Takeuchi Y, Fujita T, Fukumoto S, Yamashita T. Cloning and characterization of FGF23 as a causative factor of tumor-induced osteomalacia. Proc Natl Acad Sci USA. 2001;98:6500–6505.PubMedCrossRef

28.

Shoda N, Nakajima S, Seichi A, Kan A, Iwasaki M, Kitagawa T, Kawaguchi H, Nakamura K. Computer-assisted anterior spinal surgery for a case of recurrent giant cell tumor. J Orthop Sci. 2002;7:392–396.PubMedCrossRef

29.

Stöckle U, König B, Schaser K, Melcher I, Haas NP. [CT and fluoroscopy based navigation in pelvic surgery] [in German]. Unfallchirurg. 2003;106:914–920.PubMed

30.

Stöckle U, Krettek C, Pohlemann T, Messmer P. Clinical applications-pelvis. Injury. 2004;35(suppl 1):S-A46–S-A56.

31.

Tsuchiya H, Tomita K, Mori Y, Asada N, Morinaga T, Kitano S, Yamamoto N. Caffeine-assisted chemotherapy and minimized tumor excision for nonmetastatic osteosarcoma. Anticancer Res. 1998;18:657–666.PubMed

32.

Van Royen BJ, Baayen JC, Pijpers R, Noske DP, Schakenraad D, Wuisman PI. Osteoid osteoma of the spine: a novel technique using combined computer-assisted and gamma probe-guided high-speed intralesional drill excision. Spine (Phila Pa 1976). 2005;30:369–373.CrossRef

33.

Westendorff C, Hoffmann J, Troitzsch D, Dammann F, Reinert S. Ossifying fibroma of the skull: interactive image-guided minimally invasive localization and resection. J Craniofac Surg. 2004;15:854–858.PubMedCrossRef

34.

Wirtz CR, Knauth M, Hassfeld S, Tronnier VM, Albert FK, Bonsanto MM, Kunze S. Neuronavigation-first experiences with three different commercially available systems. Zentralbl Neurochir. 1998;59:14–22.PubMed

35.

Wong KC, Kumta SM, Chiu KH, Antonio GE, Unwin P, Leung KS. Precision tumour resection and reconstruction using image-guided computer navigation. J Bone Joint Surg Br. 2007;89:943–947.PubMedCrossRef

Title: Navigation-assisted Surgery for Bone and Soft Tissue Tumors With Bony Extension
Authors: Makoto Ieguchi, MD
Manabu Hoshi, MD, PhD
Jun Takada, MD
Noriaki Hidaka, MD, PhD
Hiroaki Nakamura, MD, PhD
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 1/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-2094-5

At a glance: The STEP trials

Springer Medicine

Navigation-assisted Surgery for Bone and Soft Tissue Tumors With Bony Extension

Abstract

Background

Questions/purposes

Methods

Results

Conclusion

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusion

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 1/2012

Can a High-flexion Total Knee Arthroplasty Relieve Pain and Restore Function Without Premature Failure?

Revision Surgery for Patellofemoral Problems: Should We Always Resurface?

Development of a New Knee Society Scoring System

Does Open Reduction of the Developmental Dislocated Hip Increase the Risk of Osteonecrosis?

Case Report: Bilateral Proximal Epiphyseal Clavicular Stress-related Lesions in a Male Gymnast

The Effect of Long-term Alendronate Treatment on Cortical Thickness of the Proximal Femur