Remarkable reduction or disappearance of retroodontoid pseudotumors after occipitocervical fusion

Report of three cases

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✓ Retroodontoid or periodontoid pseudotumor unassociated with rheumatoid arthritis or hemodialysis is clinically rare. The authors report three cases of retroodontoid pseudotumor that they treated surgically. All patients exhibited myelopathy of the upper cervical spinal cord. Plain radiography depicted atlantoaxial instability in two of the three patients. Spinal cord compression caused by a mass lesion in all patients was clearly demonstrated on magnetic resonance images. In two patients, the mass lesion was not limited to the retroodontoid region and expanded continuously to the cranial base. Posterior laminectomy of the atlas and occipitocervical fusion were performed. After surgery, the pseudotumor disappeared in two cases and was clearly reduced in one case, and neurological symptoms also improved. Retroodontoid pseudotumor is a lesion for which symptomatic improvement can be expected with posterior decompression and fusion, even without direct tumor excision.

Abbreviations used in this paper:ADI = atlas–dens interval; CRP = C-reactive protein; JOA = Japanese Orthopaedic Association; MR = magnetic resonance; WBC = white blood cell.

Article Information

Address reprint requests to: Sei Shibuya, M.D., Ph.D., Department of Orthopaedic Surgery, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kagawa 761-0793, Japan. email: shibuya@kms.ac.jp.

© AANS, except where prohibited by US copyright law.

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    Case 1. A and B: Preoperative lateral radiographs of cervical vertebrae obtained during flexion (A) and extension (B), showing atlantoaxial instability of 5 mm at the ADI. C–E: Preoperative sagittal MR images of the upper cervical spine. A T1-weighted image showing the retroodontoid pseudotumor as a low-intensity region almost isointense with the spinal cord (C). A T2-weighted image revealing a mixture of low and high intensity (D). A Gd-enhanced image depicting no contrast enhancement in the interior, although some enhancement of the surrounding capsulelike structure is observed (E). F and G: Postoperative images. A lateral radiograph (F) and a T1-weighted sagittal MR image (G) of the cervical spine obtained 12 years after surgery demonstrating no recurrence of the retroodontoid pseudotumor and continued spinal cord decompression.

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    Case 2. A and B: Preoperative lateral radiographs of the cervical spine obtained during flexion (A) and extension (B), showing atlantoaxial instability of 2 mm at the ADI. C–E: Preoperative sagittal MR images of the upper cervical spine. The retroodontoid pseudotumor extends continuously from the posterior region of the axis to the cranial base, greatly compressing the spinal cord. A T1-weighted image depicting a low-intensity region almost isointense with the spinal cord (C). A T2-weighted image revealing a low-intensity region (D). A Gd-enhanced image depicts no contrast enhancement in the interior, although some enhancement of the surrounding capsulelike structure is observed (E). The arrow denotes the deep layer and the arrowhead the superficial layer of the pseudotumor. F and G: Postoperative lateral radiograph of the cervical spine (F) and a T1-weighted sagittal MR image of the upper cervical spine obtained 10 months after surgery (G). At 20 months after surgery, the retroodontoid pseudotumor has almost disappeared.

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    Case 3 A and B: Preoperative lateral radiographs of the cervical spine obtained during flexion (A) and extension (B), depicting no atlantoaxial instability. C–E: Preoperative sagittal MR images of the upper cervical spine. A T1-weighted image showing the retroodontoid pseudotumor as a low-intensity region almost isointense with the spinal cord (C). A T2-weighted image showing a mixture of low and high intensity (D). A Gd-enhanced image demonstrating no contrast enhancement in the interior, although some enhancement of the surrounding capsulelike structure is observed (E). The arrow denotes the deep layer and the arrowhead the superficial layer of the pseudotumor. F and G: Postoperative lateral radiograph of the cervical spine (F) and T1-weighted sagittal MR image of the cervical vertebrae (G) 6 months after surgery. Despite the fact that this pseudotumor was the largest of the three cases and compression was marked, tendency toward tumor regression is observed 6 months after posterior fusion.

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