Precision in action: Using patient-specific cutting guides for en bloc resection of large sacral chordomas - A case report.

Background: Chordomas are rare malignant tumors of notochordal origin, with sacral chordomas being the most common. En bloc resection with negative margins is the preferred treatment for long-term disease control. However, the technical complexity of en bloc sacrectomy cannot be overstated. This case report highlights the use of a patient-specific 3D-printed cutting guide to assist in the precise en bloc resection of a large sacral chordoma. Case Description: A 51-year-old male with a history of refractory constipation and lower back pain was diagnosed with a large sacral chordoma. Preoperative planning included the creation of a patient-specific 3D-printed cutting guide used to make precise bony cuts while preserving critical structures. Complete en bloc resection with negative margins was achieved. The patient recovered well postoperatively; follow-up imaging at 13 months showed no tumor recurrence. At 25 months, however, a small recurrence was noted in the right piriformis/gluteal muscle. Conclusion: The use of a 3D-printed cutting guide is a novel technology that can be used to facilitate en bloc resection of bony tumors. Use of the cutting guide simplified the technical difficulty involved with more traditional methods for sacrectomy.