En Bloc Resection of Upper Thoracic Chordoma via a Combined Simultaneous Anterolateral Thoracoscopic and Posterior Approach

BACKGROUND: En bloc resection of chordomas is associated with increased patient survival. Achievement of en bloc resection, however, may present a great surgical challenge, particularly in the mobile spine. Novel multidisciplinary techniques may enable en bloc resection of lesions presenting in anatomically challenging locations. A combined simultaneous thoracoscopic and posterior approach in a patient with an upper thoracic chordoma is presented; en bloc resection was achieved. OBJECTIVE: To show the feasibility, safety, and utility of performing a thoracoscopy-assisted en bloc resection of a chordoma involving the upper thoracic spine. METHODS: A case study is presented of a patient with biopsy-proven chordoma of T2-3 with predominantly paravertebral involvement who underwent multilevel en bloc resection via a simultaneous combined anterolateral thoracoscopic and posterior approach. Thoracoscopic assistance achieved separation of the tumor and ventral spine from the adjacent mediastinal structures. En bloc resection proceeded without complication. The spine was stabilized with posterior instrumentation. RESULTS: A multilevel en bloc resection was achieved with negative margins, preserving more than half of the remaining vertebral bodies and allowing short segment posterior fixation without extension into the cervical spine. The patient remained neurologically intact. CONCLUSION: A combined simultaneous thoracoscopic and posterior approach is safe and effective for en bloc resection of multilevel chordoma involving the upper thoracic spine. This technique allows for a plane to be established ventrally between the tumor and the mediastinum, thus assisting with safe osteotomies via the posterior approach.