Surgical techniques for medial clavicular tumors: A report of 3 cases.

INTRODUCTION AND IMPORTANCE: Clavicular tumors are rare, consisting of <1 % of all skeletal tumors. In this series, we described our experience of treating medial clavicular tumors. CASE PRESENTATION: We treated three patients with medial clavicle tumors at a national tertiary referral hospital in Jakarta, Indonesia. The patients were treated with wide excision following bony reconstruction from fibular bone and one patient was treated by marginal excision. Each patient was treated by surgery and one patient underwent reconstruction using non-vascularized fibular graft and composite using bone cement. CLINICAL DISCUSSION: All patients resulted in restoration of symmetry of the lower neck and upper chest and no post-surgical complication. Based on these cases above and the extension of tumor, we recommend medial clavicle tumor resection classification divided into three type to decide which type of surgical procedure that should be performed. In our report, all patients resulted in restoration of symmetry of the lower neck and upper chest and no post-surgical complication. CONCLUSION: Clavicle resection in management of medial third clavicle tumor is technically demanding. We proposed three types of clavicular resection based on tumor extension. The surgical technique of medial end clavicle in this patient resulted in tumor free margin of medial clavicular, medial scapula, and lateral scapular incision. Reconstruction surgery following clavicle resection can be done in order to restore symmetry of the lower neck and upper chest, protect nearby neurovascular bundle, and rarely associated with significant shoulder function loss.

Acetabular reconstruction with total hip replacement and femoral head autograft following pelvic resection of malignant bone tumour: A case report.

INTRODUCTION: Pelvic tumors greatly impact survival and quality of life of the patient. Reconstruction following resection of neoplasms involving the acetabulum remains one of the most challenging procedures for orthopaedic surgeons. We reported an 18-year-old female with Hodgkin's lymphoma of the left iliac wing. PRESENTATION OF CASE: A 18-year-old female presented left hip pain since one year before admission. Pelvis X-ray demonstrated lytic lesion on the left iliac crest with moth-eaten pattern. However, the contrast-enhanced MRI showed the true extent of the tumour which engulfed the iliac crest and extended to the anterior border of the acetabulum. The acetabulum was reconstructed using femoral head autograft and total hip replacement. At six months of follow-up, CT scan of the pelvis demonstrated no tumour. No complications occurred during 14 months of follow-up. However, the patient died 28 months post surgery. DISCUSSION: In pelvic sarcomas, the utilization of this technique remains limited, as the complex anatomy and the bulk of tumour growth often limits the choice of what procedure can be conducted. Reconstruction techniques have also advanced, albeit difficult and laden with complications, especially when the lesion involves the acetabulum. CONCLUSIONS: The choice of implant for pelvic resection in the developing country remains challenging due to the high cost of implants. However, in cases of pelvic sarcomas, the utilization of this technique remains limited, as the complex anatomy and the bulk of tumour growth often limits the choice of what procedure can be conducted. Reconstruction techniques have also advanced, albeit difficult and laden with complications, especially when the lesion involves the acetabulum.

Functional outcome in intradural extramedullary tumor patients: Case series.

INTRODUCTION: Intradural extramedullary (IDEM) spinal cord tumors account two thirds of all intraspinal tumors. These tumors produce pain syndromes, a variety of neurological symptoms-motor, sensory, sphincter or a combination of thereof. Preferred treatment is microsurgical radical resection. The objective of this study was analyzed and discuss about functional outcome in IDEM. PRESENTATION OF CASE: We present serial case of 15 patients, that consist of 8 males and 7 females, with the mean age of 43,4 years old, ranging from 16 to 82 years old. The outcomes were followed up with Karnofsky Score and Tomita to analyzed metastasis of the tumor. The mean of Karnofsky score in this study was 74 with no patient had metastatic intradural tumor, therefore the Tomita score in these patients is incalculable. DISCUSSION: MRI confirmed the location and extent of the tumor for definitive diagnosis. We then performed excision of the tumor or decompression of the spinal canal followed by posterior stabilization if needed. Minimal complaint regarding pain and/or numbness were found. Post operation functional outcome of the patient is monitored using Karnofsky score. CONCLUSION: In all except one patient, the functional outcome of the patients is greater than 50 based on Karnofsky score. In this case series, the good functional outcome is due to all tumor were primary tumor which originate from the spine. Furthermore, all tumor had benign characteristic based on the anatomical pathology result. In consequence, gross total resection can be achieved thus resulting a good overall functional outcome of the patients.