Surgical Treatment of a Chordoma Arising from the Second Thoracic Vertebral Body through the Modified Anterior Approach: Case Report.
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Chordoma
Thoracic vertebrae
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Intervertebral foramen
Dumbbell
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We report herein a case of lower clival chondroid chordoma, focusing on the surgical procedure of endoscopic endonasal surgery.A 36-yearold woman presented with progressive headache, right shoulder pain, and right hypoglossal nerve palsy.Computed tomography (CT) and magnetic resonance (MR) imaging revealed an extradural tumor located in the lower clivus, including the anterior aspect of the foramen magnum, deeply compressing the medulla and upper cervical spinal cord.Endoscopic endonasal surgery was performed via two nostrils.Since the basiocciput was destroyed by the tumor, removal of the tumor allowed identification of the middle clivus superiorly, the anterior arch of the atlas inferiorly, and anteromedial parts of occipital condyles bilaterally without drilling the basiocciput.The tumor was removed except for laterally and inferiorly extended lesions.Pathological diagnosis was chondroid chordoma.Postoperative course was uneventful, and the patient was discharged without further neurological deterioration.Endonasal endoscopic surgery provided safe and reliable tumor resection for a lower clival lesion.We believe that this minimally invasive procedure should be considered as an alternative to traditional surgical treatment. KeywOrds:
Clivus
Foramen magnum
Chordoma
Endoscopic endonasal surgery
Jugular foramen
Occipital condyle
Occipital nerve stimulation
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Chordoma
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Chordoma
Lateral mass
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Chordoma
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We report a technical modification of the classic transmanubrial osteomuscular sparing approach described by Grünenwald and Spaggiari for the treatment of a T1 vertebral tumor. The goal of the surgical treatment for spinal tumors of the cervico-thoracic area is to excise the vertebral tumor, reconstruct the spinal column, and place an internal fixation device to achieve immediate stabilization. The procedure was necessary for treating a patient who presented with an invasion of T1 vertebral body by multiple myeloma with initial neurological symptoms of epidural spinal cord compression. This approach requires a multidisciplinary team, essentially composed by the thoracic surgeon, who performs the anatomical dissection of the cervico-thoracic area, and the neurosurgeon, who performs the vertebrectomy and placement of a titanium prosthesis (Harm's cage). The operation was successful; the follow-up 6 months after the surgical procedure is normal.
Vertebrectomy
Vertebral column
Spinal cord compression
Thoracic spine
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Vertebral canal
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Chordomas are histologically benign tumors with local aggressive behavior. They arise from embryological remnants of the notochord at the clivus, mobile spine, and sacrum. Chordomas are rare tumors in the pediatric age group. Their surgical management is difficult, given their propensity for inaccessible anatomical regions, and proximity to critical neurovascular structures. While en bloc resection with surgical margins has been advocated as the preferred approach for chordomas, tumor characteristics and violation of adjacent anatomical boundaries may not allow for safe en bloc resection of the tumor. Here, the authors present the case of a C1 chordoma in a 5-year-old boy with epidural and prevertebral extension. The patient's treatment consisted of a far-lateral approach for resection of the tumor and C1 arch, followed by circumferential reconstruction of the craniocervical junction with an expandable cage spanning the skull base to C2, and posterior occipitocervical spinal instrumentation. At 42 months after surgery, the patient remains neurologically intact with stable oncological status, and no evidence of craniocervical junction instrumentation failure.
Chordoma
Clivus
Axial skeleton
Neurovascular bundle
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