A procedure performed in radiology using X-rays (fluoroscopy) and intravenous (IV) contrast (dye) to look at blood vessels. A catheter (a large IV) is usually inserted in the artery in the groin area. Through this catheter, other catheters are inserted and can be fed through arteries until the artery to be studied is approached. Contrast is injected and pictures are obtained with X-rays.

The main artery that carries blood from the heart to the rest of the body.

Describes tumors that do not spread to other parts of the body. Benign tumors can reoccur and cause problems by growing and putting pressure on critical structures.

The process of obtaining a sample of tissue to determine a diagnosis. A biopsy can be percutaneous (a needle through the skin) or open (through surgery). To reduce the risk of spreading tumor, spinal and sacral chordomas should be biopsied using CT imaging and a needle through the skin. The biopsy should be planned so that the tissue along the path the needle takes to the tumor can then be removed with the tumor, if possible. Most biopsy needles today have a dual needle design in which one needle sits inside the other; this decreases the chance of tumor cells spreading to the biopsy tract.

A tumor marker for chordoma. This helps the pathologist identify a tumor as a chordoma when the tumor is being examined.

A rare tumor that occurs in 1 out of 1 million people. Chordomas are malignant — potentially fatal — and tend to grow slowly and spread to other parts of the body. Chordomas are cancerous, and treating them incorrectly can make them more likely to reoccur and spread. Chordomas tend to metastasize to the lung, but have also been known to spread to other parts of the body, including the liver, brain and even heart. A chordoma is one of the few tumors that can “seed” its cells to surrounding tissues. That means that if the tumor happens to be ruptured during surgery, tumor cells can spill into surrounding areas and grow uncontrolled.

The bottom front of the skull base. This is a portion of the skull that looks like a slide from the side. It is located behind the mouth. The brain stem sits directly behind the clivus.

Uses X-rays to create images of the inside of the body. Pictures are taken in slices, and like slices of bread, they are stacked to give a three-dimensional view of anatomy. CT scans are very good at looking at dense tissues like bone. They are not as good as MRIs for looking at nerves and tumors.

During an angiogram procedure, blood vessels can be closed off using glue or coils to decrease blood supply to an area. This can help decrease blood loss during an operation.

Refers to removing a tumor in one piece.

The tubular structure that connects the mouth to the stomach.

The growth of bone from one bone to another. Over time, the screws, rods, cages and cables used to rebuild can fatigue, loosen and potentially fracture. For long term durability, bone needs to grow from one bone to another, or fuse. Once fusion has occurred, the bone is actually stronger than the implanted metal, as bone is constantly regenerating.

A unit of measure for radiation.

The screws, rods, cages and cables used to reconstruct the spine, sacrum and pelvis. The metals used for instrumentation are titanium, steel and cobalt-chromium. Titanium is the most popular because it allows for better MRI and CT scans. Steel and cobalt-chromium are used when stiffer material is needed. PEEK (Polyether ether ketone) and carbon fiber composites are used as alternatives to metals. These plastics or composite materials may be used when proton beam radiation is planned.

A non-invasive way of looking inside the body. Soft tissues such as muscle, nerves and tumors can be seen with this technique.

Describes tumors that can spread to other parts of the body or invade other structures.

The part of the spine (not including the sacrum) that has moving joints.

Removing the tumor and any compromised surrounding tissue until only healthy tissue remains.

The structure that transmits information to and from the spinal cord or brain stem. Nerves can be thought of as wires that send electrical information.

Uses a radioactive dye that is injected through an IV. This dye is usually a radioactive sugar that concentrates in areas of high metabolism (very active cells). Some tumors have high metabolism and will light up on PET scans. Chordomas do not usually show well on PET scans.

The part of the nerve located at the junction of the nerve and the spinal cord.

Removal of the entire sacrum (S1 through S5 and the coccyx), including the S1 through S5 nerves.

Removal of part of the sacrum. Sacral amputations can be classified by how much bone is removed or by which nerves are sacrificed and which are preserved:

• Distal – a minimum of S1 through S4 are preserved
• Low – S1 through S3 are preserved
• Mid – S1 and S2 are preserved
• High – S1 is preserved

The large segment of nerves that sits within the spinal canal and transmits information from and to the brain.

The removal of an entire segment of the spine.

The tubular structure (airway) that connects the mouth and nose to the lungs.