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

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 Hsu W, "Transoral approaches to the cervical spine" 66 (66): 119-125, 2010

2 Barrenechea IJ, "Surgical management of chordomas of the cervical spine" 6 : 398-406, 2007

3 Yang X, "Sequentially staged resection and 2-column reconstruction for C2 tumors through a combined anterior retropharyngealposterior approach: surgical technique and results in 11 patients" 69 (69): ons184-ons193, 2011

4 Ropper AE, "Primary vertebral tumors: a review of epidemiologic, histological and imaging findings, part II: locally aggressive and malignant tumors" 70 : 211-219, 2012

5 Boriani S, "Primary bone tumors of the spine. Terminology and surgical staging" 22 : 1036-1044, 1997

6 Jackson RJ, "Occipitocervicothoracic fixation for spinal instability in patients with neoplastic processes" 91 (91): 81-89, 1999

7 Delgado TE, "Labiomandibular, transoral approach to chordomas in the clivus and upper cervical spine" 8 : 675-679, 1981

8 Maynard FM Jr, "International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association" 35 : 266-274, 1997

9 Cloyd JM, "En bloc resection of primary tumors of the cervical spine: report of two cases and systematic review of the literature" 9 : 928-935, 2009

10 Rhines LD, "En bloc resection of multilevel cervical chordoma with C-2 involvement. Case report and description of operative technique" 2 : 199-205, 2005

11 Arbit E, "Combined transoral and median labiomandibular glossotomy approach to the upper cervical spine" 8 : 672-674, 1981

12 McMaster ML, "Chordoma: incidence and survival patterns in the United States, 1973-1995" 12 : 1-11, 2001

13 Boriani S, "Chordoma of the mobile spine: fifty years of experience" 31 : 493-503, 2006

14 Enneking WF, "A system for the surgical staging of musculoskeletal sarcoma. 1980" (415) : 4-18, 2003