En bloc resection of a multilevel high-cervical chordoma involving C-2: new operative modalities

Abstract

<jats:p>En bloc resection of cervical chordomas has led to longer survival rates but has resulted in significant morbidities from the procedure, especially when the tumor is multilevel and located in the high-cervical (C1–3) region. To date, there have been only 5 reported cases of multilevel en bloc resection of chordomas in the high-cervical spine. In this technical report the authors describe a sixth case. A complete spondylectomy was performed at C-2 and C-3 with spinal reconstruction and stabilization, using several new modalities that were not used in the previous cases. The use of 1) preoperative endovascular sacrificing of the vertebral artery, 2) CT image-guidance, 3) an ultrasonic aspirator for skeletonizing the vertebral artery, and 4) the custom design of an anterior cage all contributed to absence of intraoperative or long-term (20 months) hardware failure and pseudarthrosis.</jats:p>

Recent advances in understanding and managing chordomas

“…However, advances in surgical resection and reconstruction techniques have allowed for more preservation of nerve roots and decreases in operative time and blood loss 58– 60 . In the case of chordomas of the mobile spine, newer techniques, such as complete spondylectomy, have been developed to widen the margin of resection and to decrease local recurrence 61, 62 .…”

A clivus plate fixation for reconstruction of ventral defect of the craniovertebral junction: a novel fixation device for craniovertebral instability

“…The complex osseous anatomy at the CVJ, as well as a great risk of injury to neurologic and vascular structures, makes any internal fixation difficult. A trimmed titanium mesh cage and/or posterior occipitocervical instrumentation was used to reconstruct the CVJ integrity following ventral resection of the lesion [2][3][4][5][6]. Subsequently, the clival screw purchase may not be optimal with a trimmed mesh cage, and such anterior fixation may migrate or break due to lack of biomechanical validation.…”

En Bloc Resection of Primary Malignant Bone Tumor in the Cervical Spine Based on 3‐Dimensional Printing Technology

“…However, various factors hamper performing this procedure in the cervical spine, including the complex anatomy, importance of VAs and cervical nerve roots, and high rate of unfavorable outcomes. Both because of these factors and the limited indications for en bloc resection, only a few reports of en bloc resection of cervical spine tumors have been published. Fujita et al .…”