Cement-augmented dorsal instrumentation of the spine as a safe adjunct to the multimodal management of metastatic pheochromocytoma: a case report
<p>Abstract</p> <p>Malignant pheochromocytoma is a neuroendocrine tumor that originates from chromaffin tissue. Although osseous metastases are common, metastatic dissemination to the spine rarely occurs.</p> <p>Five years after primary diagnosis of extra-adrenal, abdom...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2012-01-01
|
| Series: | Patient Safety in Surgery |
| Subjects: | |
| Online Access: | http://www.pssjournal.com/content/6/1/1 |
| _version_ | 1819155524573200384 |
|---|---|
| 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 | DOAJ |
| description | <p>Abstract</p> <p>Malignant pheochromocytoma is a neuroendocrine tumor that originates from chromaffin tissue. Although osseous metastases are common, metastatic dissemination to the spine rarely occurs.</p> <p>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.</p> <p>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.</p> <p>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.</p> |
| first_indexed | 2024-12-22T15:38:21Z |
| format | Article |
| id | doaj.art-0bb92e1d1fcb46afa9dc1eeba61263f5 |
| institution | Directory Open Access Journal |
| issn | 1754-9493 |
| language | English |
| last_indexed | 2024-12-22T15:38:21Z |
| publishDate | 2012-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Patient Safety in Surgery |
| spelling | doaj.art-0bb92e1d1fcb46afa9dc1eeba61263f52022-12-21T18:21:11ZengBMCPatient Safety in Surgery1754-94932012-01-0161110.1186/1754-9493-6-1Cement-augmented dorsal instrumentation of the spine as a safe adjunct to the multimodal management of metastatic pheochromocytoma: a case reportRittirsch DanielBattegay EdouardZimmerli Lukas UBaulig WernerSpahn Donat ROssendorf ChristianWanner Guido ASimmen Hans-PeterWerner Clément ML<p>Abstract</p> <p>Malignant pheochromocytoma is a neuroendocrine tumor that originates from chromaffin tissue. Although osseous metastases are common, metastatic dissemination to the spine rarely occurs.</p> <p>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.</p> <p>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.</p> <p>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.</p>http://www.pssjournal.com/content/6/1/1malignant pheochromocytomathoracic spineadrenergic blockadedorsal instrumentationcement augmentation |
| spellingShingle | 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 Patient Safety in Surgery malignant pheochromocytoma thoracic spine adrenergic blockade dorsal instrumentation cement augmentation |
| 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 | malignant pheochromocytoma thoracic spine adrenergic blockade dorsal instrumentation cement augmentation |
| url | http://www.pssjournal.com/content/6/1/1 |
| 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 |