Image-guided, endoscopic, transcervical resection of cervical chordoma

Technical note

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Chordomas are rare tumors that arise from the sacrum, spine, and skull base. Surgical management of these tumors can be difficult, given their locally destructive behavior and predilection for growing near delicate and critical structures. En bloc resection with negative margins can be difficult to perform without damaging adjacent structures and causing significant clinical morbidity. For chordomas of the upper cervical spine, surgical options traditionally involve transoral or submandibular approaches. The authors report the use of the image-guided, endoscopic, transcervical approach to the upper cervical spine as an alternative to traditional techniques for addressing upper cervical spine tumors, particularly for tumors where gross-total resection is not feasible.

Abbreviation used in this paper: VB = vertebral body.

Article Information

Address correspondence to: Wesley Hsu, M.D., Department of Neurosurgery, The Johns Hopkins University School of Medicine, Meyer Building 8-161, 600 North Wolfe Street, Baltimore, Maryland 21287. email: weshsu@jhmi.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    A and B: Preoperative T2-weighted sagittal and axial MR images showing a recurrent C-2 chordoma. C and D: Preoperative CT (sagittal reconstruction and axial image). Note the polymethylmethacrylate cement within the C-2 VB.

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    Upper: An example of patient setup for the image-guided, endoscopic, transcervical approach to the cervical spine. Lower: Intraoperative photograph. The patient is immobilized in a Mayfield head frame to facilitate intraoperative navigation.

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    A and B: Postoperative T2-weighted axial and sagittal MR images demonstrating decompression of the brainstem and spinal cord. C and D: Postoperative CT (sagittal reconstruction and axial image).

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