Operative Technique for<i>En Bloc</i>Resection of Upper Cervical Chordomas: Extended Transoral Transmandibular Approach and Multilevel Reconstruction

Ortega-Porcayo, Luis Alberto; Cabrera-Aldana, Eibar Ernesto; Arriada-Mendicoa, Nicasio; Gómez-Amador, Juan Luis; Granados-García, Martín; Coll, J

doi:10.4184/asj.2014.8.6.820

Cited by 20 publications

(11 citation statements)

References 16 publications

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“…The purpose of surgical management of upper cervical intraspinal tumors is to resect the tumor, relieve spinal cord compression, and restore spinal stability. 3 , 12 Various surgical approaches have been described for the treatment of upper cervical intraspinal tumors, including an extreme lateral approach, 13 , 14 an anterior approach, 15 , 16 and a posterior approach. 17 , 18 However, the ideal surgical approach for upper cervical intraspinal tumors located in the ventral cervical cord is still controversial because of the complicated anatomic structure.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of posterior laminectomy and pedicle screw fixation for upper cervical intraspinal tumors: a case series

Song²,

Zhang

et al. 2020

J Int Med Res

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Objective This study was performed to introduce posterior laminectomy and pedicle screw fixation for the treatment of upper cervical spinal cord tumors and investigate the curative effects. Methods Eighteen patients (11 men, 7 women) who underwent surgical treatment of an upper cervical intraspinal tumor from January 2008 to June 2013 were reviewed. Clinical parameters including age, sex, affected spinal levels, lesion location, duration and type of symptoms, and pathological features were retrospectively investigated. Results The mean operation time was 181.9 ± 25.5 minutes (range, 135–240 minutes), and the mean blood loss volume was 1038.9 ± 284.2 mL (range, 750–1530 mL). The Frankel grade, Japanese Orthopaedic Association score, and Karnofsky performance status score were significantly better postoperatively than preoperatively. The radiographic examination revealed good bone graft fusion. Two patients developed tumor recurrence, while four patients developed intraoperative or postoperative complications. Conclusions Management of upper cervical intraspinal tumors by posterior laminectomy and pedicle screw fixation can relieve compression of the cervical cord and nerve root, thoroughly remove the tumor lesion, reconstruct the stability of the upper cervical spine, and improve patients’ quality of life.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of posterior laminectomy and pedicle screw fixation for upper cervical intraspinal tumors: a case series

Song²,

Zhang

et al. 2020

J Int Med Res

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“…The anatomy in this region is highly complex and involves many critical neurovascular structures that must be preserved to maintain the patient’s post-operative functional status. The transoral approach, which was originally pioneered by Kanavel in 1917, allows for midline access to a wider surgical field with access to multiple cervical vertebrae from C1 to C4 with less compromise to key neurovascular structures [22,23]. This approach has been used in the past to access the anterior cervical spine as noted by Tuite et al in their report on 27 pediatric patients with occipitocervical junction pathology [24].…”

Section: Discussionmentioning

confidence: 99%

Benign Giant Cell Lesion of C1 Lateral Mass: A Case Report and Literature Review

et al. 2019

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Primary osseous tumors of the spinal column account for approximately 1% of the total number of spinal tumors found in the pediatric patient population. The authors present a case of a C1 benign giant cell lesion that was incidentally found in a 15-year-old patient. A transoral biopsy was performed followed by treatment with denosumab, with definitive management in the form of transoral tumor resection with subsequent occiput-cervical three posterior instrumented fusion. The patient tolerated all of the procedures well, as there were no post-operative complications, discharged home neurologically intact and was eager to return to school when assessed during a follow-up visit in clinic. Osteolytic lesions affecting the cervical spine are rare in the pediatric population. It is of utmost importance to have sufficient background knowledge in order to formulate a differential diagnosis, as well as an understanding of principles underlying surgical techniques required to prevent occipital-cervical instability in this patient population. The information presented will guide surgical decision-making by identifying the patient population that would benefit from neurosurgical interventions to stabilize the atlantoaxial junction, in the context of rare osteolytic conditions affecting the cervical spine.

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“…Another study suggested that the transmandibular approach provided wide access to C3–4 caudally. [ 17 ] The authors also described that glossotomy was necessary when the lesion extended to C2 and below and that the cosmetic deformity and functional loss were minimal despite the seemingly radical incision.…”

Section: Discussionmentioning

confidence: 99%

Outcomes following surgical management of cervical chordoma: A review of published case reports and case series

Pham

Awad

2017

Asian J Neurosurg

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Aim:This review aimed to summarize the clinical outcomes in relation to tumor resection margins of cervical chordomas.Methods:Studies that described any surgical intervention for cervical chordoma were identified. Cervical chordomas with cranial or spinal extension, purely retropharyngeal chordomas or where resection type was not reported, were excluded from the study.Results:Seventy-six articles were obtained and these reported a total of 195 patients. Seventy-six percent cervical chordoma patients had intralesional resection with adjuvant radiotherapy. Ninety-two percent chordoma recurrences and all chordoma metastases occurred in patients with intralesional resection. En bloc surgeries were longer (900 min vs. 619 min) and staged surgeries. Intralesional surgeries (2899 ml vs. 2661 ml) had greater intraoperative blood loss. Vertebral artery and nerve root sacrifice were greater in en bloc patients (35%, 39%) compared to intralesional patients (17%, 10%). Postoperative complications were more common in en bloc (54%) than in intralesional patients (11%).Conclusions:En bloc resection cervical chordomas are associated with less recurrence and no metastasis compared to intralesional resection. En bloc is possible through wide exposure of the vertebrae via a multidisciplinary team approach and utilization of particular surgical equipment. The higher rate of complications associated with en bloc surgeries may be acceptable, particularly when there is a chance of cure of disease.

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Operative Technique forEn BlocResection of Upper Cervical Chordomas: Extended Transoral Transmandibular Approach and Multilevel Reconstruction

Cited by 20 publications

References 16 publications

Clinical outcomes of posterior laminectomy and pedicle screw fixation for upper cervical intraspinal tumors: a case series

Clinical outcomes of posterior laminectomy and pedicle screw fixation for upper cervical intraspinal tumors: a case series

Benign Giant Cell Lesion of C1 Lateral Mass: A Case Report and Literature Review

Outcomes following surgical management of cervical chordoma: A review of published case reports and case series

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