Cargando…
Cement-augmented dorsal instrumentation of the spine as a safe adjunct to the multimodal management of metastatic pheochromocytoma: a case report
Malignant pheochromocytoma is a neuroendocrine tumor that originates from chromaffin tissue. Although osseous metastases are common, metastatic dissemination to the spine rarely occurs. Five years after primary diagnosis of extra-adrenal, abdominal pheochromocytoma and laparoscopic extirpation, a 53...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2012
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293075/ https://www.ncbi.nlm.nih.gov/pubmed/22222147 http://dx.doi.org/10.1186/1754-9493-6-1 |
_version_ | 1782225366660677632 |
---|---|
author | Rittirsch, Daniel Battegay, Edouard Zimmerli, Lukas U Baulig, Werner Spahn, Donat R Ossendorf, Christian Wanner, Guido A Simmen, Hans-Peter Werner, Clément ML |
author_facet | Rittirsch, Daniel Battegay, Edouard Zimmerli, Lukas U Baulig, Werner Spahn, Donat R Ossendorf, Christian Wanner, Guido A Simmen, Hans-Peter Werner, Clément ML |
author_sort | Rittirsch, Daniel |
collection | PubMed |
description | Malignant pheochromocytoma is a neuroendocrine tumor that originates from chromaffin tissue. Although osseous metastases are common, metastatic dissemination to the spine rarely occurs. Five years after primary diagnosis of extra-adrenal, abdominal pheochromocytoma and laparoscopic extirpation, a 53-year old patient presented with recurrence of pheochromocytoma involving the spine, the pelvis, both proximal femora and the right humerus. Magnetic resonance imaging and computed tomography revealed osteolytic lesions of numerous vertebrae (T1, T5, T10, and T12). In the case of T10, total destruction of the vertebral body with involvement of the rear edge resulted in the risk of vertebral collapse and subsequent spinal stenosis. Thus, dorsal instrumentation (T8-T12) and cement augmentation of T12 was performed after perioperative alpha- and beta-adrenergic blockade with phenoxybenzamine and bisoprolol. After thorough preoperative evaluation to assess the risk for surgery and anesthesia, and appropriate perioperative management including pharmacological antihypertensive treatment, dorsal instrumentation of T8-T12 and cement augmentation of T12 prior to placing the corresponding pedicle screws did not result in hypertensive crisis or hemodynamic instability due to the release of catecholamines from metastatic lesions. To the authors' knowledge, this is the first report describing cement-augmentation in combination with dorsal instrumentation to prevent osteolytic vertebral collapse in a patient with metastatic pheochromocytoma. With appropriate preoperative measures, cement-augmented dorsal instrumentation represents a safe approach to stabilize vertebral bodies with metastatic malignant pheochromocytoma. Nevertheless, direct manipulation of metastatic lesions should be avoided as far as possible in order to minimize the risk of hemodynamic complications. |
format | Online Article Text |
id | pubmed-3293075 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-32930752012-03-05 Cement-augmented dorsal instrumentation of the spine as a safe adjunct to the multimodal management of metastatic pheochromocytoma: a case report Rittirsch, Daniel Battegay, Edouard Zimmerli, Lukas U Baulig, Werner Spahn, Donat R Ossendorf, Christian Wanner, Guido A Simmen, Hans-Peter Werner, Clément ML Patient Saf Surg Case Report Malignant pheochromocytoma is a neuroendocrine tumor that originates from chromaffin tissue. Although osseous metastases are common, metastatic dissemination to the spine rarely occurs. Five years after primary diagnosis of extra-adrenal, abdominal pheochromocytoma and laparoscopic extirpation, a 53-year old patient presented with recurrence of pheochromocytoma involving the spine, the pelvis, both proximal femora and the right humerus. Magnetic resonance imaging and computed tomography revealed osteolytic lesions of numerous vertebrae (T1, T5, T10, and T12). In the case of T10, total destruction of the vertebral body with involvement of the rear edge resulted in the risk of vertebral collapse and subsequent spinal stenosis. Thus, dorsal instrumentation (T8-T12) and cement augmentation of T12 was performed after perioperative alpha- and beta-adrenergic blockade with phenoxybenzamine and bisoprolol. After thorough preoperative evaluation to assess the risk for surgery and anesthesia, and appropriate perioperative management including pharmacological antihypertensive treatment, dorsal instrumentation of T8-T12 and cement augmentation of T12 prior to placing the corresponding pedicle screws did not result in hypertensive crisis or hemodynamic instability due to the release of catecholamines from metastatic lesions. To the authors' knowledge, this is the first report describing cement-augmentation in combination with dorsal instrumentation to prevent osteolytic vertebral collapse in a patient with metastatic pheochromocytoma. With appropriate preoperative measures, cement-augmented dorsal instrumentation represents a safe approach to stabilize vertebral bodies with metastatic malignant pheochromocytoma. Nevertheless, direct manipulation of metastatic lesions should be avoided as far as possible in order to minimize the risk of hemodynamic complications. BioMed Central 2012-01-05 /pmc/articles/PMC3293075/ /pubmed/22222147 http://dx.doi.org/10.1186/1754-9493-6-1 Text en Copyright ©2012 Rittirsch et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Rittirsch, Daniel Battegay, Edouard Zimmerli, Lukas U Baulig, Werner Spahn, Donat R Ossendorf, Christian Wanner, Guido A Simmen, Hans-Peter Werner, Clément ML Cement-augmented dorsal instrumentation of the spine as a safe adjunct to the multimodal management of metastatic pheochromocytoma: a case report |
title | Cement-augmented dorsal instrumentation of the spine as a safe adjunct to the multimodal management of metastatic pheochromocytoma: a case report |
title_full | Cement-augmented dorsal instrumentation of the spine as a safe adjunct to the multimodal management of metastatic pheochromocytoma: a case report |
title_fullStr | Cement-augmented dorsal instrumentation of the spine as a safe adjunct to the multimodal management of metastatic pheochromocytoma: a case report |
title_full_unstemmed | Cement-augmented dorsal instrumentation of the spine as a safe adjunct to the multimodal management of metastatic pheochromocytoma: a case report |
title_short | Cement-augmented dorsal instrumentation of the spine as a safe adjunct to the multimodal management of metastatic pheochromocytoma: a case report |
title_sort | cement-augmented dorsal instrumentation of the spine as a safe adjunct to the multimodal management of metastatic pheochromocytoma: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293075/ https://www.ncbi.nlm.nih.gov/pubmed/22222147 http://dx.doi.org/10.1186/1754-9493-6-1 |
work_keys_str_mv | AT rittirschdaniel cementaugmenteddorsalinstrumentationofthespineasasafeadjuncttothemultimodalmanagementofmetastaticpheochromocytomaacasereport AT battegayedouard cementaugmenteddorsalinstrumentationofthespineasasafeadjuncttothemultimodalmanagementofmetastaticpheochromocytomaacasereport AT zimmerlilukasu cementaugmenteddorsalinstrumentationofthespineasasafeadjuncttothemultimodalmanagementofmetastaticpheochromocytomaacasereport AT bauligwerner cementaugmenteddorsalinstrumentationofthespineasasafeadjuncttothemultimodalmanagementofmetastaticpheochromocytomaacasereport AT spahndonatr cementaugmenteddorsalinstrumentationofthespineasasafeadjuncttothemultimodalmanagementofmetastaticpheochromocytomaacasereport AT ossendorfchristian cementaugmenteddorsalinstrumentationofthespineasasafeadjuncttothemultimodalmanagementofmetastaticpheochromocytomaacasereport AT wannerguidoa cementaugmenteddorsalinstrumentationofthespineasasafeadjuncttothemultimodalmanagementofmetastaticpheochromocytomaacasereport AT simmenhanspeter cementaugmenteddorsalinstrumentationofthespineasasafeadjuncttothemultimodalmanagementofmetastaticpheochromocytomaacasereport AT wernerclementml cementaugmenteddorsalinstrumentationofthespineasasafeadjuncttothemultimodalmanagementofmetastaticpheochromocytomaacasereport |