An Anterior Transdiaphragmatic Approach for En Bloc Resection of a Giant Thoracolumbar Chordoma: A Case Report

A 54-year-old man presented with a giant T10-L2 chordoma. The tumor encased the thoracoabdominal aorta, presenting a significant challenge for en bloc resection. We used a novel anterior transperitoneal and transdiaphragmatic approach. By longitudinally incising the diaphragm along the aortic hiatus, we obtained direct visualization to safely dissect the aorta from the tumor in both thoracic and abdominal cavities. This facilitated a successful 2-stage en bloc spondylectomy and reconstruction with a three-dimensional-printed vertebral body. At 24 months, the patient was neurologically intact with no recurrence.

This approach offers a safe strategy for large thoracolumbar tumors involving critical vasculature.