Resection of an upper cervical aneurysmal bone cyst and spinal reconstruction using a midline mandibular osteotomy in a pediatric patient

Abstract

<jats:p>The authors report on the surgical management of an extensive lesion of the upper cervical spine that required an uncommon transmandibular approach to facilitate exposure, resection, and stabilization in a pediatric patient. A 6-year-old boy with a large aneurysmal bone cyst of the C-2 vertebra presented with progressive weakness and right-sided neck pain. The lesion extended laterally into the soft tissue of the neck, inferiorly to C-4, and posteriorly around the spinal cord. A transmandibular osteotomy was performed to provide adequate exposure for complete resection of the mass and anterior C1–3 instrumentation and fusion. Subsequently, the patient underwent occiput to C-4 posterior instrumentation and fusion. The patient tolerated the operation well and had regained all function at 3 and 11 months' follow-up. No neurological complications or problems of speech, swallowing, or respiration occurred. Even in pediatric patients, the transmandibular approach for the treatment of upper cervical spine lesions is an effective method of maximizing exposure for complex lesions requiring resection and stabilization.</jats:p>

Bilateral sagittal split mandibular osteotomies for enhanced exposure of the anterior cervical spine in children: technical note

“…27 Other methods described include a midline mandibular osteotomy for transoral approach. 19 The use of C1-2 spacers is another potential approach in reducing basilar invagination and atlantoaxial instability; however, further development in the pediatric population and especially with pediatric patients who have complex craniocervical abnormalities is required. 14,25,29,33 An important potential benefit to BSSMO compared with this technique is the incorporation of internal fixation, thus avoiding the need for a halo.…”

Spinal aneurysmal bone cyst in children: systematic review of the literature

“…Хирургическое удаление. По мнению большинства авторов, развитие неврологического дефицита является основным показанием к хирургическому удалению АКК позвоночника у детей [18][19][20]. В зависимости от объема удаления опухолевых тканей принято выделять субтотальную и en-blocрезекцию, результаты которых значительно различаются, в первую очередь по частоте отдаленного рецидива.…”