Elsevier

World Neurosurgery

Volume 90, June 2016, Pages 698.e1-698.e5
World Neurosurgery

Case Report
En Bloc Resection and Reconstruction Using a Frozen Tumor-Bearing Bone for Metastases of the Spine and Cranium from Retroperitoneal Paraganglioma

https://doi.org/10.1016/j.wneu.2015.09.102Get rights and content

Background

Paragangliomas are neuroendocrine tumors that originate from autonomic nervous system−associated paraganglia and are rare tumors accounting for only 0.3% of all neoplasms. Malignant paragangliomas frequently spread to the skeleton. The authors present a case of malignant paraganglioma with bone metastases to the spine and cranium, as well as excellent local control achieved with en bloc tumor resection and reconstruction using frozen tumor-bearing bone for the sites of the metastases.

Case

The patient was a 61-year-old woman who underwent retroperitoneal paraganglioma resection 12 years previously. Nine years after the primary surgery, she began to experience back pain. Magnetic resonance imaging revealed an isolated metastasis in T6, and the following evaluation detected another metastasis in the left temporal bone. We performed curative surgeries for the metastases, including total en bloc spondylectomy of T6, partial craniectomy for the cranial metastasis, and spinal and cranial reconstruction using frozen tumor-bearing bone for the sites of the metastases. At the 24-month follow-up examination, bone fusion was achieved between the frozen bone and the adjacent healthy bone in the spine and cranium. At 36 months postoperatively, an asymptomatic metastatic lesion was found in the pelvis. Nevertheless, no local recurrences at the surgical sites were detected. Her quality of life and performance in activities of daily living were well preserved. To the author's knowledge, this is the first report to present a case of cranioplasty achieved using a liquid nitrogen frozen, tumor-bearing autologous bone flap in a single-stage operation.

Section snippets

History and Evaluation

A 61-year-old woman underwent retroperitoneal paraganglioma resection 12 years previously. Nine years after the primary surgery, she began to experience back pain. Initial clinical examination at another clinic revealed a spinal tumor at T6, and she was referred to our hospital for further evaluation and treatment. On admission, she reported significant back pain, which deteriorated her performance in activities of daily living (ADLs). However, she did not have any neurologic deficits. Computed

Discussion

Ayala-Ramirez et al. published findings of a retrospective study of 128 patients with malignant pheochromocytoma and paraganglioma.5 The majority of patients with malignant paragangliomas developed bone metastases (71%), with the most frequent sites of bone metastases being the spine (81%), sacrum and pelvis (67%), proximal and distal long bone (49%), and cranium (21%). Additionally, 38% of patients with metastases had bone metastases at the diagnosis of the primary tumor. With regard to SREs,

Conclusion

We encountered a case of malignant paraganglioma with bone metastases to the spine and the cranium. Our preferred treatment method of en bloc resection for the spinal and cranial metastases and reconstruction using liquid nitrogen frozen, tumor-bearing bone was successful. Three years postoperatively, the patient's ADL and QOL were preserved, there was no local recurrence, and the reconstructions were maintained.

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Conflict of interest statement: None of the authors received any relevant financial or material supports associated with this study.

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