Excision Of Tumor Research Articles

Full-thickness chest wall reconstruction after resection of recurrent desmoid-type fibromatosis

Introduction. Desmoid-type fibromatosis (DF) is a benign but locally infiltrative soft tissue tumor that develops from fascia and musculoaponeurotic tissue with high local recurrence rate. The aim of this article was to present a case of recurrent DF of the chest wall and chest wall reconstruction after tumor resection. Case outline. A 62-year-old man came for an examination due to a tumor localized on the right anterior chest wall. The previous year, the patient had undergone surgical excision of DF of the abdominal wall. Physical examination found a firm and painless 6?7 cm mass on the right side of the chest wall with no swelling of superficial lymph nodes. A computed tomography scan revealed a homogenous mass of soft tissue density, measuring 7.12 ? 4.23 cm, arising from right anterolateral wall of thoracic cage with adjoining ribs destruction. The patient was taken to surgery, and right thoracotomy was done with excision of tumor along with resection of the eighth, nineth and tenth rib. The results of pathological examination were consistent with the frozen section, and the patient was diagnosed with DF. Despite the absence of postoperative radiotherapy, there was no evidence of local recurrence two years later. Conclusion. Surgical treatment of recurrent DF of the chest wall requires a wide resection with negative margins. Multidisciplinary approach in case of full-thickness defect of the chest wall and combination of pedicled muscle flap and polypropylene mesh are important to provide chest wall stability.

Trapdoor Deformity Correction Post Nasal Bilobed Flaps for Basal Cell Carcinoma Reconstruction With Multiple Laser Modalities.

In case of excision of nasal basal cell carcinoma (BCC), bilobed flaps are considered the criterion standard of reconstruction for defect less than 15 mm in size. However, there is still a risk of trapdoor deformity formation, of which its treatment is less discussed. A 44-year-old woman who was diagnosed with nasal BCC and underwent tumor excision with bilobed flap reconstruction presented with trapdoor deformity postoperatively. The computed Vancouver Scar Scale was 7. After early intervention of multiple laser modalities, including 2 sessions of 585-nm pulsed dye laser with a fluence of 9 J/cm2, pulse duration of 6 milliseconds, and spot size of 6 mm, 2940-nm Er-yttrium aluminum garnet (YAG) laser with a pulse energy of 800-900 mJ, repetition rate of 8-9 Hz, and laser spot size of 3-7 mm, and 5 sessions of 1064-nm Nd:YAG fractional picosecond laser with a pulse energy of 2.30-2.70 mJ, repetition rate of 8 Hz, and laser spot size of 6 mm from 5 to 23 weeks postoperatively, the Vancouver Scar Scale score improved to 1, with significant reduction of trapdoor scar erythema and puffiness. Although BCC is often curable, tumor excision causes unsatisfactory appearance satisfaction problem, owing to the apparent location of the lesion. Factors, such as sebaceous tissue thickness, reconstruction over multiple aesthetic subunits of nose, and damage to nasal cartilage framework structure during tumor removal, may increase the risk of trapdoor formation. Early intervention with multiple laser treatment can significantly revise the deformity.

Subtotal Thigh Flap for Large Abdominal Wall Defect Reconstruction in Patient With Recurrent Dermatofibrosarcoma Protuberans: A Case Report and Literature Review.

Harvesting an adequate-sized flap is challenging for reconstructing large defects on the abdominal wall. A subtotal thigh flap would be one of the choices as it provides a well-vascularized large flap with muscle components. Moreover, dermatofibrosarcoma protuberans (DFSP) is a low-grade dermal neoplasm with a high recurrence rate. There is still no consensus on the extent of resection to prevent a recurrence. We present a case of a patient who underwent the reconstruction of a large abdominal wall defect with a subtotal thigh flap after the resection of recurrent DFSP. A 59-year-old man killed from a recurrent huge mass in the lower abdomen with an invasion of the small intestine. His baseline characteristics and records of operations, medications, and outcomes were reviewed. After tumor excision, a 28 × 30-cm subtotal thigh flap was harvested from his left thigh to reconstruct the abdominal defect. A microvascular anastomosis with left deep inferior epigastric vessels was made eventually. The flap was in good condition, and the donor site was covered with a split-thickness skin graft. Subtotal thigh flap may be considered for large abdominal wall defect reconstruction as it allows good perfusion of relatively large skin paddles compared with other free flaps. Also, patients with DFSP need definite margin-free resection and close follow-up to prevent a recurrence.

Etiology and Differential Diagnoses of Nuchal Tumors: A Study of 61 Cases.

Compared to other cervical localizations, masses of the nuchal region are rare in the clinical practice of otolaryngologists. This study presents the relevant etiologies of nuchal tumors. This study included 61 cases (5.3%) from 1,150 consecutive cervical biopsies/neck tumor excisions between 2010 and 2022. Lipomatosis or Madelung fat neck diagnoses were excluded. Seventy-seven percent of the biopsies included lymph node tissue. Among the patients, 26 were female and 35 were male. The average diameter of the tumors was 3.5 cm (1.5-9 cm). Of the 33 non-malignant formations (54%, 42.3 years), lymphadenopathy (e.g., toxoplasmosis and tuberculosis) was found in 58% of cases. Lipomas were most common among benign tumors (8 out of 14). Malignant tumors (46%, 63.4 years) included lymphomas (10 cases, 6 recurrences) and metastases (18 cases). The metastases were predominantly squamous cell carcinomas of the pharynx (9 cases, 5 recurrences) and the skin (7 cases, 4 recurrences), as well as two cases of adenocarcinomas from the lung and pancreas. Indications of the malignant genesis of a nuchal mass include older patient age and a history of carcinomas in the head and neck region. In carcinomas of the posterior and parietal scalp and neck skin, the nuchal region should be included in the staging and follow-up examinations.

Central Pancreatectomy - A Novel Surgical Technique Single Institution Experience.

Children evaluated for abdominal pain are increasingly recognized to have pancreatic lesions by imaging modalities. Malignant lesions of the pancreas have also been diagnosed at regular intervals, the most common being solid cystic pseudopapillary neoplasm (SPT) - Borderline (uncertain malignant potential). Surgical resection of this tumor should provide adequate tumor free margins and also should preserve pancreatic tissue. Radical resection of the pancreas will lead to pancreatic insufficiency. Herein, we describe the technique of central pancreatectomy wherein tumor excision gives adequate clearance but preserves the pancreatic tissue, thereby reducing significant morbidity. Three children ages ranging between 11 to 12 years diagnosed to have SPT were included in the study. All children underwent successful central pancreatectomy and had an uneventful post operative recovery. Central pancreatectomy offers a good volume of remanant pancreas preserving near normal pancreatic function making it an ideal procedure for select cases.

Simultaneous excision of intrathoracic solitary fibrous tumor and retroperitoneal schwannoma with robot-assisted surgery

Simultaneous excision of intrathoracic solitary fibrous tumor and retroperitoneal schwannoma with robot-assisted surgery

Endoneurosurgical Resection of Parenchymal and Intraventricular Lesions Using Tubular Retraction System.

Endoscopic surgery has emerged in the recent years as an alternative to the conventional microsurgical approaches for removal of the deep-seated brain and intraventricular tumors. Endoport has enhanced the tumor access and visualization without any significant brain retraction. In this chapter, we describe the surgical technique of the endoscopic excision of the deep-seated intra-axial brain tumors using tubular retraction system with review of the literature. The endoscopic endoport technique that we use at our institution for the surgical management of intraventricular and intraparenchymal brain tumors has been described in details with illustrations. Results from the literature review of brain parenchymal and intraventricular port surgery were analyzed, and the feasibility and safety of this technique were discussed. Surgical complication avoidance and management were highlighted. The port technique offers numerous potential advantages, including: (1) reducing focal brain injury by distributing retraction forces homogenously; (2) minimizing white matter disruption and the risk of fascicles injury during cannulation; (3) ensuring stability of the surgical corridor during the procedure; (4) preventing inadvertent expansion of the corticectomy and white fiber tract dissection throughout surgery; (5) protecting the surrounding tissues against iatrogenic injuries caused by instrument entry and reentry. The endoport-assisted endoscopic technique is a safe and minimally invasive method that offers an effective alternative option for resection of intraventricular and parenchymal brain lesions. Excellent outcome comparable to other surgical approaches can be achieved with acceptable complications.

Endoport-Guided Endoscopic Excision of Intraaxial Brain Tumors.

Transcortical approaches using a spatula-based retraction system have traditionally been used for the microsurgical resection of deep-seated intraventricular and parenchymal brain tumors. Recently, transparent cylindrical or tubular retractors have been developed to provide a stable corridor to access deeper brain lesions and perform bimanual microsurgical resection. The flexible endoports minimize brain retraction injury during surgery and, along with the superior vision of endoscopes, offer several advantages over standard microsurgery. In this chapter, we describe the surgical technique of the endoport-guided endoscopic excision of deep-seated intraaxial brain tumors. The endoscopic endoport technique that we use at our institution for the surgical management of intraventricular and intraparenchymal brain tumors has been described in detail with illustrative cases. Results from the literature review of intraventricular and intraparenchymal port surgery were analyzed, and the feasibility and safety of this technique were discussed. Surgical complication avoidance and management were highlighted. The port technique offers numerous potential advantages, including (1) reducing focal brain injury by distributing retraction forces homogenously, (2) minimizing white matter disruption and the risk of fascicle injury during cannulation, (3) ensuring the stability of the surgical corridor during the procedure, (4) preventing inadvertent expansion of the corticectomy and white fiber tract dissection throughout surgery, and (5) protecting the surrounding tissues against iatrogenic injuries caused by instrument entry and reentry. The endoport-assisted endoscopic technique is safe and offers an effective alternative option for the resection of intraventricular and intraparenchymal lesions.

Intra-axial Supratentorial Tumours Resection under Fluorescein Guidance with 560 nm Yellow Filter: A Cross-sectional Study

Introduction: Excision of intra-axial tumours with maximal resection and minimal deficits is one of the intricate procedures in neurosurgery. Fluorescence-guided Surgery (FGS) helps in better identification of tumour tissue and allows Maximal Safe Resection (MSR) of high-grade brain tumours. Sodium fluorescein dye, when injected intravenously, gets concentrated in High-grade Glioma (HGG) tissue due to a disrupted BloodBrain Barrier (BBB), thus aiding in MSR, Extent Of Resection (EOR), and Gross Total Resection (GTR). Aim: To assess the effectiveness of intraoperative use of sodium fluorescein in achieving MSR and GTR. Materials and Methods: This was a cross-sectional study conducted on 30 patients with HGG who underwent surgery between January 2021 and May 2023 at SDM College of Medical Sciences, Dharwad, Karnataka, India. Two groups of 15 patients each were divided into those operated with the use of Fluorescein Sodium (FS) and those without FS. FS was administered at a dose of 5 mg/kg at the time of craniotomy. The primary endpoint was the number of patients with Histopathological Examination (HPE)-confirmed HGGs showing no contrast-enhancing tumour in the immediate postoperative Magnetic Resonance Imaging (MRI). Secondary endpoints included residual tumours on postoperative MRI, Focal Neurological Deficits (FND), and FS-related toxicity. The association between FS status and recurrence at different treatment time points was assessed using the Pearson Chisquare test. Recurrence rates were compared in each FS group using the Cochran Q test. Statistical significance was set at a 5% level (p-value<0.05). Results: Homogeneous or heterogeneous yellow-green fluorescence was observed on the tumour tissue in all 15 patients (100%). Of the 15 patients where FS was used, two showed lesion recurrences at six months, and 13 showed recurrences at 12 months. Among the 15 patients where FS was not used, 11 showed recurrences at six months, and four showed recurrences at 12 months. This indicates that MSR, GTR, and EOR can be improved using FS intraoperatively during tumour resection. Conclusion: Based on the results, fluorescein dye with a 560 nm yellow filter under a highly illuminated microscope can help achieve better tumour resection with minimal injury to surrounding eloquent areas. It can be utilised as an ideal adjunct for tumour resection rather than with a microscope alone.

Fully Endoscopic Nontubular Retractor Approach for Intraaxial Tumors.

Fully endoscopic or endoscope-controlled approaches are essentially keyhole approaches in which rigid endoscopes are the sole visualization tools used during the whole procedure. At the early attempts of endoscope-assisted cranial surgery, it was noted that rigid endoscopes enabled overcoming the problem of suboptimal visualization when small exposures are used. The technical specifications and design of the currently available rigid endoscopes are associated with a group of unique features that define the endoscopic view and lay the basis for its superiority over the microscopic view during brain surgery. Fully endoscopic resection of intraparenchymal brain tumors is a minimally invasive approach that is not routinely practiced by neurosurgeons, with a few major series published so far. Unfamiliarity with the technique, steep learning curve, and concerns about inadequate exposure and decreased visibility may explain this fact. The majority of the purely endoscopic resections for intraparenchymal brain lesions are performed nowadays through tubular retractor systems. In very limited instances, however, the fully endoscopic technique is performed without tubular retractors. In this chapter, we elaborate on the surgical technique and nuances of the fully endoscopic nontubular retractor approach for intraaxial tumors. From a prospective database of endoscopic procedures maintained by the senior author, clinical data, imaging studies, and operative charts and videos of cases undergoing fully endoscopic excision for intraaxial brain tumors were retrieved and analyzed. The pertinent literature was also reviewed. The surgical technique of the fully endoscopic nontubular retractor approach for intraaxial tumors was formulated. The endoscopic technique has many advantages over the conventional procedures. In our hands, the technique has proven to be feasible, efficient, and minimally invasive with excellent results.

Wound Healing Outcomes Following Treatment With Synthetic Hybrid-Scale Fiber Matrix After Resection of Soft Tissue Tumors or Infections

Background. Wide excision of soft tissue tumors or infections often results in large defects that can be challenging to manage. Advanced treatment modalities—including NPWT, skin grafts, and xenografts—can all be considered for post-resection wound management, but each has its limitations. An SHSFM, engineered to resemble human extracellular matrix, has demonstrated positive wound healing outcomes in prior studies. Materials and Methods. Adult patients at a single institution who underwent resection of soft tissue tumor or infected tissue followed by treatment with SHSFM from 2020-2023 were retrospectively reviewed. Results. Ten patients were included in the review after meeting the inclusion criteria. Overall, 7 of 10 wounds had documented complete closure, with 3 lost to follow-up. Average time to wound closure was 119 days. Patients either healed via secondary intention or were bridged to a split-thickness skin graft. The average VSS score was 3.3 when assessed. Conclusion. The current case series demonstrated that the SHSFM can support granulation tissue formation over exposed structures as a bridge to skin graft or can completely reepithelialize large wounds without skin grafting. The SHSFM offers a novel treatment option for post-resection surgical wounds.

Microsurgical Excision of Large Cerebellopontine Angle Tumors in Limited Resource Setting: Adapted Techniques and Operative Outcomes

Microsurgical Excision of Large Cerebellopontine Angle Tumors in Limited Resource Setting: Adapted Techniques and Operative Outcomes

Megaprosthesis Elbow Replacement in Chronic Nonunion of Distal Humeral Fracture

Abstract Megaprosthesis replacement of the joints is mainly indicated to manage the bone defects caused by the excision of malignant tumors. Megaprosthesis replacement of the elbow is comparatively less done as compared to the knee joint. In posttraumatic sequelae of elbow injuries like chronic nonunion of distal humeral fracture with bone defects, the megaprosthesis replacement of the elbow can be a viable option to restore the function and stability of the elbow. We present here a case of chronic nonunion of the distal humerus managed successfully by megaprosthesis replacement of the elbow.

Does excision of giant cell tumor from the finger affect sensorineural innervation?

Giant Cell Tumor of the Tendon Sheath (GCTTS), often manifested as a nodular mass in the hand, presents significant challenges for surgical intervention, particularly when located in the fingers. This study aimed to evaluate the impact of GCTTS excision on sensory function and to explore the relationship between surgical outcomes and factors such as smoking and nerve dissection. A retrospective analysis was conducted on 28 patients diagnosed with GCTTS in the fingers, who underwent surgical excision between March 2017 and March 2023. Preoperative and postoperative sensory functions were assessed using two-point discrimination and Semmes-Weinstein monofilament tests. The results indicated no significant difference in sensory function 6 months post-surgery, suggesting that meticulous surgical technique can mitigate the risk of iatrogenic nerve damage. The study highlights the importance of comprehensive diagnostic methodologies, including thorough medical history, physical examination, and radiological imaging, in guiding surgical strategies. Moreover, it emphasizes the significance of meticulous preoperative planning and the potential for preserving sensory function following GCTTS excision.

Perceptions and Attitudes of Primary Care Physicians Toward Dermatologic Surgery.

Dermatologic surgery is a well-established subspecialty in dermatology that involves various therapeutic and esthetic procedures. To date, perceptions of primary care physicians (PCPs) regarding dermatologic surgery are poorly understood. This study aimed to assess the perception and attitude of PCPs toward dermatologic surgery and explore the factors that might affect their perception and attitude toward it. This cross-sectional study used an online survey. The survey was distributed among PCPs working in various regions of Saudi Arabia and contained questions about demographics, medical training information, participants' awareness of dermatologic surgery, and a list of 10 cutaneous procedures to select the most qualified physician performing these procedures. Univariate and multivariate analyses were performed. P≤0.05 was considered statistically significant. In total, 440 PCPs participated in this study. Overall, 70% of the PCPs had heard about dermatologic surgery, whereas 30% had never heard about it. PCPs reported that dermatologic surgeons were the most qualified physicians to perform laser procedures (60.5%), hair transplantation (60.5%), excision of small benign and malignant skin tumors (46.1%), excision of small melanocytic nevi (55.7%), filler injection (44.8%), and injection of botulinum toxin (48.9%); 64.5% considered plastic surgeons to be the most qualified for liposuction. Both physicians were equally selected for performing cyst excision, procedures involving the fingernails and toenails, and scar correction. Multivariate analysis showed that female physicians had heard significantly more about dermatologic surgery (P=0.047, OR: 1.57, 95% CI: 1.006-2.45) and reported that dermatologic surgeons were the most qualified physicians (P=0.042, OR: 1.51, 95% CI: 1.016-2.25) than male physicians. PCPs working at secondary and tertiary health care hospitals heard more about dermatologic surgery (P=0.015, OR: 2.36, 95% CI: 1.18-4.71) than those working at primary health care centers. Most PCPs were aware of dermatologic surgery and recognized dermatologic surgeons as the most qualified physicians to perform most cutaneous procedures.

Tumor-induced osteomalacia due to a phosphaturic mesenchymal maxillary tumor

ABSTRACT Tumor-induced osteomalacia is a rare paraneoplastic syndrome with hypophosphatemia due to renal phosphate wasting. The clinical presentation is bony pains and muscle wasting. A 23-year-old male presented to us in a wheelchair with joint pain and muscle weakness for 5 years. There was no history of a similar disease in the family. Treatment with non steroidal anti inflammatory drugs, steroids, and infliximab was unsuccessful. Positive examination findings revealed tenderness and swelling in both ankle and knee joints, tenderness in hip joints, proximal myopathy, and power grade 4/5 in the proximal leg muscles. On evaluation, he was found to have severe hypophosphatemia [serum phosphate 1.2 mg/dl], decreased renal phosphate absorption [tubular maximum for phosphate reabsorption adjusted for glomerular filtration rate (TMP/GFR) of 1.04], increased fibroblast growth factor 23 (FGF23), and decreased 1,25 dihydroxy vitamin D levels. Fluorodeoxyglucose-positron emission tomography (FDG PET-CT) revealed a left maxillary tumor. Histopathology revealed a mesenchymal tumor. Tumor excision resulted in cure of the patient’s symptoms and the normalization of serum phosphate levels and TMP/GFR.

Surgical treatment of breast precancers - our experience.

Thanks to mammographic screening and the improvement of breast cancer diagnostics, the detection of precancers is also increasing. They are defined as morphological changes of the mammary gland which are more likely to cause cancer. The evaluated precancers are atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS) and radial scar. In the period 1. 1. 2018-31. 12. 2022, we performed 1,302 planned operations for breast disease at the Surgical Clinic of Teaching Hospital Plzeň, of which 30 (2%) were precancer operations. ADH was confirmed 11×, LCIS 8×, and a radical scar 11×. The average age of the patients in all three groups was 56 years (27-85). Precancer was diagnosed 8× only by sonography, 3× by mammography and 19× by a combination of both methods. Subsequently, a puncture biopsy was always completed. We performed 28 tumor excisions with intraoperative biopsy and 2 mastectomies. In the case of ADH from puncture biopsy, ADH was confirmed intraoperatively 8×, DCIS was diagnosed 2×, and mucinous carcinoma 1×. In LCIS, no tumor wasfound by intraoperative biopsy 4×, LCIS was confirmed 1×, lobular invasive carcinoma was diagnosed 1×, mastectomy was performed 2× without intraoperative biopsy. In the radial scar, ADH was diagnosed 3×, sclerosing adenosis 6×, DCIS 1×, invasive carcinoma 1×. After the final histological processing of the samples, there was an increase in diagnosed carcinomas. In ADH, DCIS was confirmed 3×, DIC 2×, and mucinous carcinoma 1×. In LCIS, LIC was diagnosed 3×. In the radial scar, DCIS was confirmed 1×, and invasive carcinoma remain 1×. Thus, carcinoma was diagnosed in 11 patients (37%) thanks to the surgical solution. No patient underwent axillary node surgery. All 11 patients subsequently underwent oncological treatment, always a combination of radiotherapy and hormone therapy. All patients are alive, 10 patients are in complete remission of the disease, one with DCIS experienced a local recurrence after 4 years. Surgical treatment of precancers of the breast makes sense, DCIS or even invasive cancer is often hidden in addition to precancer. Thanks to the surgical solution, the cancer was detected in time.

Midface microvascular reconstruction after maxillary complex tumor resection: A retrospective study

The study purpose is to review the surgical approach and evaluate the results in managing patients with advanced midface and maxillary complex tumors.The most common anatomical site of the primary tumor was the maxilla, sometimes with extension to the orbit and anterior fossa, parotid and middle ear or even the lip. Surgical resection included maxillectomy in the majority of cases, combined with orbital exenteration or orbitectomy and anterior fossa resection. Parotidectomy and mastoidectomy/core petrosectomy were also performed. Reconstruction was performed with radial forearm osteocutaneous free flap, latissimus dorsi myocutaneous flap with scapular bone flap, lengthening temporalis myoplasty, rectus abdominis free flap, anterolateral thigh flap, in combination with temporalis and vastus lateralis, as well as pectoralis major myocutaneous flap.A total of 36 midface tumor excisions were performed, followed by the appropriate reconstruction. The average follow-up period was 15 years. To date, 23 patients are disease free, while 6 patients presented disease recurrence and 7 patients died during the 15-year follow-up period.Surgical resection remains the gold standard for midface tumors management. When safely performed, combined with microvascular and dynamic face reconstruction, surgery can offer improvement in quality of life and prolong the overall survival.

Ectopic thyroid tissue presenting as a carotid body paraganglioma

Ectopic thyroid tissue is a rare developmental abnormality, typically presenting with midline ectopia due to incomplete embryological migration via the thyroglossal duct. The presence of ectopic thyroid tissue lateral to the midline is very rare, accounting for 1–3% of all ectopic thyroid tissue. Clinically, these lesions are often mistaken for other diagnoses including enlarged lymph nodes or metastatic tumours. We present a case of lateral ectopic thyroid tissue presenting as a presumed carotid body paraganglioma in a middle-aged woman. The patient presented with a slow-growing lateral neck mass which was clinically and radiologically consistent with a carotid body paraganglioma. She subsequently underwent tumour excision after which histological analysis identified ectopic thyroid tissue with no evidence of malignancy.

Metastatic Myxoid Liposarcoma on the Upper Thoracic Spine Treated with a Less Invasive Technique

Liposarcoma, a common soft-tissue sarcoma, includes myxoid liposarcoma (MLS) as its second-most frequent subtype. MLS primarily affects the thigh region during the fourth to fifth decades of life and often metastasizes to the spine. Managing spinal metastases is complex, with pedicle screw anchoring strength being a key concern. Various techniques address this issue, including the use of exoskeleton cement with polymethylmethacrylate (PMMA). We present a case of a 37-year-old male with MLS metastatic to the spine, experiencing lower-extremity weakness despite prior tumor excision and chemotherapy. Posterior decompression and fusion were performed, revealing inadequate screw anchoring. To address this, we applied exoskeleton cement with PMMA, resulting in improved pain but limited motor and sensory recovery. Spinal metastases, especially in the context of liposarcoma, significantly impact patient well-being. Surgical resection remains the primary treatment, but challenges arise due to tumor size and anatomical complexities. Bone mineral density (BMD) and pedicle screw stability are closely related, emphasizing the importance of addressing BMD-related issues in surgical planning. Augmented cement, such as PMMA, can enhance screw anchoring, but the risk of cement leakage must be considered. Exoskeleton cement is a promising technique but necessitates further research for comprehensive evaluation and refinement. In conclusion, the rise in spinal metastatic disease underscores the need for effective management strategies. MLS’s propensity to metastasize to the spine highlights the importance of tailored treatment approaches. Techniques like exoskeleton cement show promise in addressing screw anchoring issues but require additional investigation.