2023-08-15 01:00:59
According to the INEGI, during 2020, 90,603 cases of malignant tumors were registered in Mexico.
Cervical chordoma is such a rare tumor that it is the first time it has been diagnosed within the ISSSTE in the last 25 years.
A team of oncologists and neurosurgeons removed 90% of the tumor to restore mobility in the patient’s extremities.
Thanks to interdisciplinary work the Institute of Security and Social Services for State Workers (ISSSTE) accomplished a feat of great dimensions. All part of the timely diagnosis and care of a rare tumor with a very low incidence. While through the correct preparation of the staff it was possible to offer comprehensive care to the patient who is now recovering satisfactorily.
What happened?
The rarely seen event occurred in the National Medical Center (CMN) “November 20” of the CDMX. With a highly complex successful operation, surgical oncologists and neurosurgeons freed a 31-year-old young man from spinal cord damage and irreversible brain risk diagnosed with a cervical chordoma. It is such a rare neoplasm that it is the first time in 25 years that it has been registered within the Institute.
“The tumor was limiting the mobility of my hands and feet, I began to lose sensation on the right side, and even my breathing muscles, which caused me difficulty breathing. I was confined to a wheelchair and to get up I had to help myself with a cane,” shared the patient Víctor Alan Cabrera Sánchez, a worker at the National Institute of Statistics and Geography (Inegi).
In this regard, the CEO of the ISSSTE, Pedro Zenteno Santaella, congratulated and praised the work of the multidisciplinary team of specialists who participated in this case. Combining technology, experienced human resources, multidisciplinary care, and humanism, this type of result is achieved, focused on the greatest benefit in health, as is the case of Alan, who was rescued from a progressively deteriorating condition.
“With the help of the surgical oncologists who approached the tumor on July 3, the neurosurgery team of this hospital performed the highly specialized procedure and managed to remove up to 90 percent of the lesion, with which we were able to decompress the spinal cord and the nerves that were trapped, obtaining a functional recovery of the patient 24 hours later, and it has been increasing until today”, informed the neurosurgeon and leader of the procedure, Cuauhtémoc Gil Ortiz-Mejía.
For his part, the patient arrived at the CMN with a diagnosis of cervical chordoma after previous surgery performed at the Tlahuac General Hospital. In the first instance, they placed a titanium box to support the damaged vertebrae and at that moment they decided not to intervene in the tumor due to the risk of injuring compromised brain structures. Unfortunately, it continued to grow, causing complications.
“We must say, the most dangerous part of this surgery, apart from the complexity of removing the tumor, was avoiding the risk that we could injure the right vertebral artery and cause irreversible brain and spinal cord damage. We formed a multidisciplinary team with surgical oncologists and neurosurgeons to find a surgical alternative to offer the young man, who had practically become disabled”.
Work done during operation
Previously, by means of an MRI in axial sections, it was identified that the tumor had already destroyed part of the bone of the cervical vertebrae 2 and 3 inside the titanium case. The cord was totally strangled, compressed and thinned.
Among the medical technologies used for care were two contrast-enhanced MRIs. One was made of special cuts to define the size of the tumor, which was five centimeters long by four wide and three thick, and one made of fine cuts to establish the approach strategy.
While during surgery a C-arm was used to locate the lesion area; a neurophysiology transoperative monitoring team guided to corroborate that the patient was recovering his functions as the marrow was decompressed. A high-resolution microscope was also used to work with an augmented reality of the tumor and differentiate the tumor tissue from the spinal cord and nerves, in order not to damage them and protect the main vertebral artery.
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