En bloc resection of a multilevel high-cervical chordoma involving C-2: new operative modalities

Technical note

Kern H. Guppy M.D., Ph.D.1,2, Indro Chakrabarti M.D., M.P.H.1,2, Richard S. Isaacs M.D.3, and Jae H. Jun M.D., D.D.S.4
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  • 1 Department of Neurosurgery,
  • | 3 Department of Head and Neck Surgery, and
  • | 4 Division of Maxillofacial Surgery, The Kaiser Permanente Medical Group, Sacramento, California; and
  • | 2 Department of Neurosurgery, University of California San Francisco Medical Center, San Francisco, California
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En bloc resection of cervical chordomas has led to longer survival rates but has resulted in significant morbidities from the procedure, especially when the tumor is multilevel and located in the high-cervical (C1–3) region. To date, there have been only 5 reported cases of multilevel en bloc resection of chordomas in the high-cervical spine. In this technical report the authors describe a sixth case. A complete spondylectomy was performed at C-2 and C-3 with spinal reconstruction and stabilization, using several new modalities that were not used in the previous cases. The use of 1) preoperative endovascular sacrificing of the vertebral artery, 2) CT image-guidance, 3) an ultrasonic aspirator for skeletonizing the vertebral artery, and 4) the custom design of an anterior cage all contributed to absence of intraoperative or long-term (20 months) hardware failure and pseudarthrosis.

Abbreviation used in this paper:

GDC = Guglielmi detachable coil.

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