Complicated Surgical Resection of Malignant Tumors in the Upper Cervical Spine After Failed Ion-Beam Radiation Therapy

Matsumoto, Morio; Watanabe, Kota; Ishii, Ken; Tsuji, Takashi; Takaishi, Hironari; Nakamura, Masaya; Toyama, Yoshiaki; Chiba, Kazuhiro; Imanishi, Yorihisa; Kishi, Kazuo; Kawana, Hiromasa

doi:10.1097/brs.0b013e3181caa86c

Cited by 18 publications

(15 citation statements)

References 16 publications

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“…Although surgical/biopsy pathway recurrences and subcutaneous metastasis are likely to benefit from a radical treatment with curative intent based on en bloc wide resection and/or a new full dose irradiation, nodal as well as prevertebral and leptomeningeal recurrences associated with cervical primaries, as in our series, are rarely accessible to a second radical treatment, such as surgery or reirradiation.…”

Section: Discussionmentioning

confidence: 79%

“…7,8 Treatment options for local recurrences include reirradiation and reoperationwith a high morbidity. [9][10][11][12] However, the ectopic recurrence patterns are rarely described within remote structures, such as regional lymph nodes, surgical/biopsy pathway, and distant viscera, which account for 3%, 4.5%, and 20% of the total failures observed in the largest series, respectively. 8 Surgical/biopsy pathway recurrence occurs as a result of direct implantation of the tumor into adjacent tissue during the transit of instruments and tissue during the surgery.…”

Section: Relapse Of Chordomas and Their Prognosismentioning

confidence: 99%

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Investigation of ectopic recurrent skull base and cervical chordomas: The Institut Curie's proton therapy center experience

et al. 2015

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Section: Discussionmentioning

confidence: 79%

Section: Relapse Of Chordomas and Their Prognosismentioning

confidence: 99%

Investigation of ectopic recurrent skull base and cervical chordomas: The Institut Curie's proton therapy center experience

et al. 2015

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“…The approach-related complication rate was 2.4%, which was lower than that reported by Traynelis 7 (12.9%), who performed the subaxial anterior approach, and lower than those who performed the retropharyngeal approach (range, 12%-20%). 13,16,[45][46][47][48] The results of the current series proved that the subaxial anterior approach could provide adequate and safe exposure for decompression and instrumentation at C2 in patients with a mandible angle higher than the C3 superior endplate on lateral extension cervical radiographs. However, the subaxial anterior approach may not be limited in these patients.…”

Section: Discussionmentioning

confidence: 93%

Application of the Cervical Subaxial Anterior Approach at C2 in Select Patients

Zhang¹,

Zhang²,

Wang³

et al. 2013

Orthopedics

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The purpose of this study was to assess the feasibility and radiographic indications of using the subaxial anterior approach for decompression and fusion at C2. Anterior exposure at C2 was difficult and associated with increased morbidity. The subaxial anterior approach is easy and familiar to spine surgeons but did not provide satisfying exposure in all patients. This article describes a series of patients undergoing anterior surgery involving C2 through the subaxial anterior approach. Patients were selected based on lateral extension radiographs showing a mandibular angle higher than the C3 upper endplate. Forty-two patients (29 men and 13 women) with average age of 45 years and an average follow-up of 9.7 months were reviewed. Etiologies included Hangman's fracture (n=35), traumatic disk herniation at C2-C3 (n=1), C3 fracture (n=2), ossification of the posterior longitudinal ligament (n=2), and tumor (n=2). Single-level diskectomy (n=36) and corpectomy (n=6) were performed. Exposure was satisfactory, and operations went smoothly in all patients except in 1 man with a muscular neck. One (2.4%) postoperative complication of choking and trouble swallowing liquids was observed and diminished in 3 months with no treatment. Pre- and postoperative Japanese Orthopaedic Association scores were 13.86 ± 2.25 and 16.50 ± 0.76, respectively, with an improvement rate of 85% ± 24% in 14 patients who had preoperative neurological dysfunction. A fusion rate of 100% was achieved. The subaxial anterior approach may be simple and safe for exposure at C2 in select patients. Complicated exposure, such as the transoral or retropharyngeal approach, should be avoided in these patients.

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“…The log-rank test demonstrated that upper-level cervical chordomas are related to a worse prognosis, which is a finding supported by various reports in the literature. 29,39 It is well known that clear exposure in the upper cervical region is more challenging than in the lower cervical region, 26,38 and therefore complete resection of the tumor tissue can be very difficult sometimes due to the complicated nearby structures. In our series, incomplete tumor removal was detected in 2 patients (Cases 1 and 9) in whom tumors were present in the upper cervical vertebrae.…”

Section: Discussionmentioning

confidence: 99%

Primary chordomas of the cervical spine: a consecutive series of 14 surgically managed cases

Wang¹,

Xiao²,

Wu³

et al. 2012

SPI

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Chordomas in the cervical spine are usually neoplasms that exhibit insidious growth and a wide extension by the time of diagnosis. Radical intralesional debulking surgery and postoperative radiotherapy have been effective treatment. A limited application of en bloc tumor resection and the highly likely intraoperative intralesional tumor seeding may partially explain the high local recurrence rate, whereas the chance of distant metastases, fortunately, is very low. Most recurrence were documented within 3 years. Some specific surgical techniques should be emphasized to minimize tumor seeding. Patients with upper cervical chordomas, younger adults, and elderly adults have worse prognosis. For patients with chordoma extending to both the anterior and posterior spinal columns, total spondylectomy combined with piecemeal excision is recommended for a better prognosis.

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Complicated Surgical Resection of Malignant Tumors in the Upper Cervical Spine After Failed Ion-Beam Radiation Therapy

Cited by 18 publications

References 16 publications

Investigation of ectopic recurrent skull base and cervical chordomas: The Institut Curie's proton therapy center experience

Investigation of ectopic recurrent skull base and cervical chordomas: The Institut Curie's proton therapy center experience

Application of the Cervical Subaxial Anterior Approach at C2 in Select Patients

Primary chordomas of the cervical spine: a consecutive series of 14 surgically managed cases

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