Chordoma is a rare form of cancer affecting one in one million, which occurs in the bones at the skull base on spine that typically grow asymptomatic for years and can cause paralysis or even be lethal. 27 years old Noah Pernikoff found out after being in a car accident giving him nagging neck pain leading to an X-ray revealing the surprising diagnosis unrelated to the accident and far more concerning than the minor injuries endured. After recovering from injuries he was sent to a neurosurgeon for evaluation, who recommended biopsy that resulted in chordoma diagnosis. Location was in C2 vertebrae making treatment challenging.
A multidisciplinary team was assembled to plan removal using a complex and equally rare surgical approach; using a trans-oral robotic approach for the second part of the surgery to improve recovery. Trans-oral robotics is the first group of minimally invasive robotic surgery techniques to remove tumors of the throat and mouth developed at Penn. Stakes were high due to tumor placement, removal could compromise integrity of the spine, leading to paralysis, loss of fine motor skills, or other complications such as loss of smell, or regrowth if it all was not removed.
Surgery was done in three parts. Entering through the back of neck, neurosurgeons cut the the spine around the tumor to prepare for the second phase, tumour removal through the mouth. Second phase was key, making ultrasonic bone cuts to remove pieces of bone around the tumor without touching it and injuring the spinal cord. The team used the surgical robot to clear a path for tumor removal and part of the spinal column through the mouth intact. Phase three reconstructed the spinal column using bone removed from the patient’s hip and rods to stabilize the newly built spine portion. Nine months after the procedure the patient is back to work, and actually thankful for his car accident that provided diagnosis and the quality life saving care he received at Penn Medicine.
This groundbreaking procedure is revolutionary thanks to the advanced capabilities of the technology and skilled professionals operating it. Versatility of TORS was demonstrated showing how useful it can be in tumor removals.
