Asian Spine J.  2014 Dec;8(6):820-826. 10.4184/asj.2014.8.6.820.

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

• Ortega-Porcayo LA
• Cabrera-Aldana EE
• Arriada-Mendicoa N
• Gomez-Amador JL
• Granados-Garcia M
• Barges-Coll J

• KMID: 2270225
• DOI: http://doi.org/10.4184/asj.2014.8.6.820

Abstract

Anterior exposure for cervical chordomas remains challenging because of the anatomical complexities and the restoration of the dimensional balance of the atlanto-axial region. In this report, we describe and analyze the transmandibular transoral approach and multilevel spinal reconstruction for upper cervical chordomas. We report two cases of cervical chordomas (C2 and C2-C4) that were treated by marginal en bloc resection with a transmandibular approach and anterior-posterior multilevel spinal reconstruction/fixation. Both patients showed clinical improvement. Postoperative imaging was negative for any residual tumor and revealed adequate reconstruction and stabilization. Marginal resection requires more extensive exposure to allow the surgeon access to the entire pathology, as an inadequate tumor margin is the main factor that negatively affects the prognosis. Anterior and posterior reconstruction provides a rigid reconstruction that protects the medulla and decreases axial pain by properly stabilizing the cervical spine.

Keyword

Transmandibular approach; Chordoma; Neurosurgical instrumentation; Spinal neoplasms

MeSH Terms

Chordoma*
Humans
Neoplasm, Residual
Pathology
Prognosis
Spinal Neoplasms
Spine