title: En Bloc Resection and Reconstruction Using a Frozen Tumor-Bearing Bone for Metastases of the Spine and Cranium from Retroperitoneal Paraganglioma.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan. Electronic address: ryo415k@gmail.com.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kitagawa
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Murakami
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kato
authors.affiliation: Department of Neurosurgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Nakada
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Demura
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
mesh_terms: D016025:Bone Transplantation / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003399:Craniotomy / Q000379:methods; D015925:Cryopreservation / Q000379:methods*; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D012888:Skull Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cranium metastasis; En bloc resection; Frozen tumor-bearing bone; Liquid nitrogen; Paraganglioma; Spinal metastasis; Surgical reconstruction