🏥 Recently at Peking University First Hospital, our team managed an anatomically demanding case of a T1 vertebral chondrosarcoma.
🏥 Recently at Peking University First Hospital, our team managed an anatomically demanding case of a T1 vertebral chondrosarcoma.
[Diagnostic Dilemma] 🔬 The patient presented with numbness in the right hand and ulnar forearm. Imaging revealed a tumor extensively invading the T1 vertebra, right transverse process, and bilateral lamina, encasing the right C8 and T1 nerve roots.
🩸 Since chondrosarcoma is highly insensitive to chemoradiotherapy, achieving an en bloc resection with negative surgical margins is the only definitive pathway to long-term survival.
⚠️ However, the T1 region is a recognized high-risk surgical exclusion zone. It is tightly bordered by the trachea, esophagus, major vessels, and the brachial plexus, making catastrophic hemorrhage or high-level paralysis a significant risk during resection.
[Surgical Nuances] 💡 To navigate this anatomical bottleneck, we utilized multimodal image fusion and 3D printing. As shown in the attached 3D reconstruction model, this allowed precise preoperative delineation of tumor margins and osteotomy trajectories.
🔪 A combined anterior-posterior approach was executed via MDT collaboration. As seen in the intraoperative field image, the anterior approach successfully isolated and protected critical structures including the phrenic nerve, subclavian artery, and vertebral artery.
[Clinical Pearls] 🧩 The orthopedic oncology team then completed the highly demanding en bloc resection from the posterior approach. The intact gross specimen, shown in the attached photos, demonstrates an unruptured tumor capsule, effectively preventing iatrogenic tumor seeding.
[Take-home Message] 🔩 A custom 3D-printed artificial vertebral body was implanted for sequence reconstruction. The patient recovered smoothly with no new neurovascular deficits, proving that meticulous MDT planning and digital orthopedic technology can conquer the most challenging spinal segments.