Three-dimensional fluoroscopic navigation-assisted surgery for tumors in patients with tumor-induced osteomalacia in the bones

Figures & data

Figure 1. A 40-year-old female patient with the tumor of distal femur (#4). (a) Antero-posterior radiograph did not show the tumor clearly. (b, c) Axial and coronal views of computed tomography showed an obscure sclerotic lesion at the lateral epicondyle near the joint space. (d) Positron emission tomography showed positive FDG uptake in the tumor. (e, f) Axial and coronal views of the intraoperative 3D C-arm image. (g) Curettage was performed with the navigation system and reconstructed with artificial bone. (h) Postoperative computed tomography confirmed complete resection of the tumor.

Table 1. Characteristics of the patients with tumor-induced osteomalacia.

								Surgery
Case	Age	Sex	Location	Pathology	Size	Disease course (years)	Follow-up (months)	Curettage or segmental resection	Adjuvant therapy	Navigation	Additional excision	Time (h)	Blood loss (mL)	Recurrence
1	64	F	Ilium	PMT	60	3	23	Segmental resection	HSB	+	−	3.45	745	−
2	45	M	Intertrochanteric lesion of the femur	PMT	10	2	16	Curettage	HSB	+	−	2.26	45	−
3	53	M	Lateral epicondyle of the femur	PMT	38	7	125	Curettage	HSB	−	−	1.5	20	+
							70	Curettage	HSB	+	+	4.08	140	−
4	40	F	Distal femur	PMT	10	2	76	Curettage	HSB	+	−	2.24	0	−
5	59	M	Subtrachanteric lesion of the femur	PMT	5	3	68	Curettage	HSB	+	+	3.26	20	−
6	62	M	Vertebral body and pedicle of L1	PMT		5	89	Curettage and segmental resection and posterior fusion	−	+	−	8.27	2105	+
							89	Curettage and anterior fusion	−	−	−	7.33	1760	+
7	69	F	Ischium	PMT	50	25	149	Curettage	−	−	−	2	1234	+

PMT: phosphaturic mesenchymal tumors; HSB: high-speed burring.

Table 2. Preoperative and postoperative laboratory values.

	FGF-23		Normalization of P		Normalization of ALP
Case	Before ope	Day 1 after ope	Before ope	Day after ope	Before ope	Month after ope
1	111	<3 pg/mL	2.1	3	1079	12
2	337	10.6	1.7	4	871	6
3	2000	2000	1.5	–	306	–
	3066	14.3	2.5	3	442	18
4	161.5	<3 pg/mL	1.7	5	1198	8
5	98.9	9.7	2	3	1242	9
6	>1000	>1000	2.2	–	668	–
7	Unknown	Unknown	–	–	–	–

FGF-23: fibroblast growth factor-23; Ope: operation; P: phosphorus; ALP: alkaline phosphatase.

Figure 2. Comparison among three surgical methods. (a) Number of recurrence after using the three different methods for TIO in previous reports and in the present study. (b) Comparison of recurrence rate by Bayesian estimation. Navi: navigation system.