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Yao H, Duan P, Zhu X, Zhong Y, Li X, Wang H, Chou D. Treatment of Benign C2 Tumors with Transoral Curettage and Posterior Instrumentation with Minimum 2-Year Follow-Up: Technical Note. Neurol India 2022; 70:68-73. [DOI: 10.4103/0028-3886.336331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Baro V, Garbin E, Sartori L, Caliri SL, Furlanis GM, Santoro L, Dal Pos S, Landi A, Denaro L. Metastatic osteosarcoma of craniovertebral junction with cervicalgia and torticollis an a pediatric patient. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Gallazzi E, Cannavò L, Perrucchini GG, Morelli I, Luzzati AD, Zoccali C, Scotto G. Is the Posterior-Only Approach Sufficient for Treating Cervical Spine Metastases? The Evidence from a Case Series. World Neurosurg 2019; 122:e783-e789. [DOI: 10.1016/j.wneu.2018.10.147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/20/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
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Vazifehdan F, Karantzoulis VG, Igoumenou VG. Surgical treatment for metastases of the cervical spine. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017. [DOI: 10.1007/s00590-017-2002-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kavakebi P, Girod PP, Hartmann S, Tschugg A, Thomé C. Transoral vertebroplasty of the lateral mass of C1 using image guidance. Acta Neurochir (Wien) 2017; 159:1159-1162. [PMID: 28374147 PMCID: PMC5425509 DOI: 10.1007/s00701-017-3158-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/20/2017] [Indexed: 11/02/2022]
Abstract
BACKGROUND Osteolytic lesions of the anterior aspects of C1 (lateral mass) are difficult to address in a minimally invasive fashion and are often treated by craniocervical instrumentation. METHODS We report the feasibility and technical method of transoral vertebroplasty of the lateral mass of the atlas using image guidance and describe the workflow of the procedure. To our knowledge, there has not yet been a technical description of a transoral vertebroplasty using image guidance. RESULTS Adequate positioning of the pedicle access needle using image guidance for addressing the lateral mass of C1 through a transoral, permuceous access can be achieved. CONCLUSIONS With the assistance of image guidance, it is safe and feasible to access the lateral mass of the atlas. This constitutes a minimally invasive and fast alternative for introducing the bone needle to C1 rather than using a fluoroscopic device alone.
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Yang J, Jia Q, Peng D, Wan W, Zhong N, Lou Y, Cai X, Wu Z, Zhao C, Yang X, Xiao J. Surgical treatment of upper cervical spine metastases: a retrospective study of 39 cases. World J Surg Oncol 2017; 15:21. [PMID: 28088217 PMCID: PMC5237490 DOI: 10.1186/s12957-016-1085-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/22/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The surgical treatment of upper cervical spine metastases are controversial up to now. By summarizing and analyzing the clinical data of the upper cervical spine involved metastases treated surgically in our center, we mainly aimed to investigate the surgical decisions and outcomes so as to provide more references for the clinical treatment of this special and complex spine metastasis. METHODS We evaluated the patients' pre- and post-operative neck pain and neurologic function with paired t test, followed by the statistics of the selection of surgical approaches, ways of reconstruction, and related complications. Moreover, the Kaplan-Meier survival analysis was adopted to analyze the patients' survival according to different growth group (rapid, moderate, and slow). RESULTS There were 39 patients with atlantoaxial metastases in this study. The most common symptom (94.87%) was occipital-cervical pain, which relieved greatly after surgical interventions (p < 0.01). The metastases mainly resulted from lung cancer and nasopharyngeal cancer with an incidence of 38.46 and 10.26%, respectively. As to different growth group, the rapid-growth tumors accounted for 69.23% in all atlantoaxial metastases. Tumor resection and stabilization were performed mainly via the combined anterior and posterior approach (66.67%). The 1-, 2-, and 3-year overall survival rate at the last follow-up was 58.5, 40, and 28.3%, respectively, with a median survival time of 18 months. The rate of complications associated with the surgical intervention was 12.82% (5/39), which is lower than that of the previous reports and generally controllable. CONCLUSIONS Relatively radical interventions with surgery for upper cervical spine metastases offered satisfactory outcomes with a low mortality. Together with adjuvant therapy, surgical treatment benefits patients with atlantoaxial metastases by relieving regional pain, restoring or improving the neurologic function, stabilizing the quality of life, and prolonging the survival time of such patients.
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Affiliation(s)
- Jian Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Qi Jia
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Dongyu Peng
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Wei Wan
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Nanzhe Zhong
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Yan Lou
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xiaopan Cai
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Zhipeng Wu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Chenglong Zhao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xinghai Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
| | - Jianru Xiao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
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Management Strategy of Osteoblastomas Localized in the Occipitocervical Junction. World Neurosurg 2016; 97:505-512. [PMID: 27756672 DOI: 10.1016/j.wneu.2016.10.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this article was to analyze extracted patient data from the literature and highlight the best treatment options and survival outcomes for osteoblastomas in the occipitocervical region. METHODS A systematic literature search method was used to select articles containing information about the demographic features, tumor location, treatment characteristics, adjuvant therapies, and follow-up time. RESULTS From 25 articles, 31 cases of osteoblastoma in the occipitocervical junction were selected for analysis. Average patient age was 17 years (range, 5-57 years); there were 21 male (67%) and 10 female (33%) patients. All patients had cervical pain as the presenting symptom. Other symptoms included torticollis (0.13%) and sensory or motor neurologic deficits (0.16%). The average follow-up time was 41 months, and the local recurrence rate was 0.125%. Recommendations of each article are categorized and discussed in detail. CONCLUSIONS Osteoblastoma is a rare entity in the occipitocervical region, so treatment experiences are limited and mostly based on case reports. To determine the best treatment for these lesions, osteoblastomas should be staged using the Enneking staging system; different methods may be recommended for different stages, and the feasibility of fusion depends on the remaining amount of bony structures and joints. Additional adjuvant therapies may be recommended only in special cases.
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Yang JS, Chu L, Xiao FT, Zhang DJ, Wang Y, Chen L, Ke ZY, Hao DJ, Deng ZL. Anterior retropharyngeal approach to C1 for percutaneous vertebroplasty under C-arm fluoroscopy. Spine J 2015; 15:539-45. [PMID: 25523378 DOI: 10.1016/j.spinee.2014.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 11/25/2014] [Accepted: 12/08/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Percutaneous vertebroplasty (PVP) has proven to be a valuable palliative treatment option for patients with medically refractory painful osteolytic metastases of the spine. Percutaneous vertebroplasty of the atlas has been reported in only seven articles and has been performed with different techniques and approaches. PURPOSE To describe the technique we used to perform PVP of a lytic lesion of the lateral mass of C1 via anterior retropharyngeal approach guided by C-arm fluoroscopy. STUDY DESIGN A technical report. PATIENT SAMPLE It included a 75-year-old man with known metastatic lung carcinoma and incapacitating right suboccipital and neck pain refractory to conventional medical treatment. Radiologic evaluation showed revealed osteolytic destruction of C1 and C2, mainly invading the right lateral mass of C1 and the vertebral body of C2. OUTCOME MEASURES The right suboccipital and neck pain was measured using the visual analog scale (VAS). METHODS Under C-arm fluoroscopy, a novel anterior retropharyngeal approach, through the vertebral body of C2 into the metastatic osteolytic vertebral lesion of C1, was performed to achieve the PVP in C1 followed by a PVP in C2. RESULTS Immediately after the operation, the patient reported substantial pain relief (from VAS 9/10 preoperatively to 3/10). At 12 hours postoperatively, the range of motion was also improved. There were no surgery-related complications. The immediately postoperative cervical plain film and computed tomography scan showed adequate filling of the osteolytic lesion without the obvious leakage of bone cement. Clinical follow-up at 3 months revealed that this pain condition was improved and maintained (VAS 1/10). CONCLUSIONS When the transoral approach is unsuitable or contraindicated, the anterior retropharyngeal approach could be an efficacious alternative in selected patients with C1 metastasis, providing adequate filling of bone cement and significant pain relief. Based on our preliminary exploration, only assisted by C-arm fluoroscopy, this approach is feasible to achieve PVP in C1 under local anesthesia and intravenous analgesia. Nevertheless, when considering the substantial potential risks, this technically challenging procedure should be performed by experienced operators.
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Affiliation(s)
- Jun-Song Yang
- Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China; Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Lei Chu
- Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China
| | - Fu-Tao Xiao
- Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China
| | - Dong-Jie Zhang
- Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China
| | - Yang Wang
- Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China
| | - Liang Chen
- Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China
| | - Zhen-Yong Ke
- Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China
| | - Ding-Jun Hao
- Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Zhong-Liang Deng
- Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi'an Jiaotong University, No. 76 Nanguo Road, Beilin District, Xi'an, 710054, Shanxi province, China.
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Abstract
The skeletal system is the third most common site of metastases after the lung and liver. Within the skeletal system, the vertebral column is the most common site of metastases, and 8% to 15% of vertebral metastases are in the cervical spine, consisting, anatomically and biomechanically, of the occipitocervical junction, subaxial spine, and cervicothoracic junction. The vertebral body is more commonly affected than the posterior elements. Nonsurgical management techniques include radiation therapy (stereotactic and conventional), bracing, and chemotherapy. Surgical techniques include percutaneous methods, such as vertebroplasty, and palliative methods, such as decompression and stabilization. Surgical approach depends on the location of the tumor and the goals of the surgery. Appropriate patient selection can lead to successful surgical outcomes by restoring spinal stability and improving quality of life.
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Miller C, Khan R, Lemole GM, Jacob A. Osteoblastoma of the lateral skull base: work-up, surgical management, and a review of the literature". J Neurol Surg Rep 2013; 74:37-42. [PMID: 23943719 PMCID: PMC3713558 DOI: 10.1055/s-0033-1346978] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 02/25/2013] [Indexed: 10/26/2022] Open
Abstract
Objectives To describe the work-up and surgical management of an osteoblastoma involving the lateral skull base. Typically occurring in the spine or long bones, osteoblastomas of the craniofacial skeleton are exceedingly rare and infrequently reported. A review of the current literature regarding temporal bone osteoblastoma, diagnosis, and treatment is described. Methods This case report describes the clinical presentation, radiographic studies, surgical management, histology, and postoperative follow-up of a young man presenting to a tertiary care neurotology practice with osteoblastoma involving the lateral skull base. A review of the current literature regarding osteoblastoma of the skull base, work-up, and treatment is described. Results A 15-year-old adolescent boy with a greater than 1-year history of right-sided retroauricular pain, a palpable postauricular mass, and chronic headaches presented for evaluation/management. Microscope examination of the ears, hearing, and cranial nerve function were normal. High-resolution temporal bone computed tomography and magnetic resonance imaging scans were obtained, which revealed an expansile mass involving the junction of the temporal and occipital bones. The patient underwent a combined retrosigmoid/retrolabyrinthine resection of this extradural tumor. Histology revealed a benign bone neoplasm consistent with osteoblastoma. Complete surgical resection was achieved, and the patient's symptoms fully resolved. Follow-up imaging studies found no evidence of recurrence. The scientific literature relevant to work-up and management of osteoblastoma is reviewed. Discussion Osteoblastomas of the lateral skull base are rare, histologically benign tumors that can present with radiographic features suggestive of malignancy. An en bloc resection is important for both diagnosis and definitive treatment of these neoplasms. The differential diagnosis on imaging and histology is discussed.
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Affiliation(s)
- Craig Miller
- Division of Otolaryngology, The University of Arizona Ear Institute, University of Arizona, Arizona, USA
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Transoral approach for percutaneous vertebroplasty in the treatment of osteolytic tumor lesions of the lateral mass of the atlas: feasibility and initial experience in 2 patients. Spine (Phila Pa 1976) 2013; 38:E193-7. [PMID: 23165216 DOI: 10.1097/brs.0b013e31827d41c7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case series. OBJECTIVE To report our early experience of percutaneous vertebro-plasty via a transoral approach of the lesions of the lateral mass of C1. SUMMARY OF BACKGROUND DATA Percutaneous vertebroplasty has gained acceptance for the treatment of osteolytic lesions of the spine. However, scant data are available on the percutaneous vertebroplasty of the C1 lesions. METHODS Two patients (a 74-yr-old female and a 53-yr-old male) presenting respectively a metastasis of the left lateral mass of C1 from a pancreatic adenocarcinoma and a hemangioma of the left lateral mass of C1 underwent a percutaneous vertebroplasty via a transoral approach in a hybrid angio suite associating a monoplane flat panel and a computed tomography scan, using polymethylmetacrilate bone cement.For the second patient, a nondetachable balloon was used to protect the vertebral artery from cement leakage. RESULTS Satisfactory filing of the lesions was obtained in both patients. No complication was recorded. Both patients experienced pain improvement. CONCLUSION Transoral approach for the treatment of osteolytic tumor lesions of the lateral mass of the atlas is feasible and seems to be a safe and effective technique.
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