Management of pediatric clival chordoma with extension to the craniocervical junction and occipito-cervical fusion: illustrative case

BACKGROUND Chordomas are rare malignant neoplasms that develop from the primitive notochord with < 5% of the tumors occurring in pediatric patients younger than the age of 20. Of these pediatric chordomas, those affecting the craniocervical junction (C1–C2) are even more rare; therefore, parameters for surgical management of these pediatric tumors are not well characterized. OBSERVATIONS In this case, a 3-year-old male was found to have a clival chordoma on imaging with extension to the craniocervical junction resulting in spinal cord compression. Endoscopic-assisted transoral transclival approach for clival tumor resection was performed first. As a second stage, the patient underwent a left-sided far lateral craniotomy and cervical laminectomy for resection of the skull base chordoma and instrumented fusion of the occiput to C3. He made excellent improvements in strength and dexterity during rehab and was discharged after 3 weeks. LESSONS In pediatric patients with chordoma with extension to the craniocervical junction and spinal cord compression, decompression with additional occipito-cervical fusion appears to offer a good clinical outcome. Fusion performed as a separate surgery before or at the same time as the initial tumor resection surgery may lead to better outcomes.

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Caudal cervical arthrodesis using a distractable fusion cage in a dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-09-02-0025 ◽

2010 ◽

Vol 23 (03) ◽

pp. 209-213 ◽

Cited By ~ 10

Author(s):

F. Bernard ◽

J.-F. Bardet ◽

Adrega da Silva

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cord Compression ◽

Neurological Deficits ◽

Cervical Fusion ◽

Disc Protrusion ◽

Dynamic Component ◽

Long Term Outcome ◽

Fusion Cage

SummaryThis case report describes a cervical fusion cage, surgical technique and the long-term outcome of caudal cervical arthrodesis used to stabilise dynamic spinal cord compression at the sixth and seventh cervical intervertebral disc space (C6, C7) in a dog. A seven-year-old, 41 kg, entire male Dobermann Pinscher was admitted for progressive ataxia of two weeks duration. Neurological examination revealed ambulatory tetraparesis. Computed tomographic myelogram scans in neutral and traction positions of the neck were performed and were used to determine presence of a dynamic component. A C6-C7 surgical distraction and stabilisation using a distractable intervertebral fusion cage was performed. There was not any deterioration of neurological status was observed on postoperative neurological evaluation. Within eight weeks after surgery, gait and postural abilities had returned to normal. Computed tomography evaluation indicated a complete bridging callus within and outside the cage at 15 weeks after surgery. There were not any complications or recurrences of initial neurological deficits observed during the 40 month follow-up period. Based on the follow-up period data, a C6-C7 dynamic spinal cord compression with disc protrusion was successfully treated by a distractable cervical fusion cage.

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Partial Tumor Resection Combined with Chemotherapy for Multiple Myeloma Spinal Cord Compression

Annals of Surgical Oncology ◽

10.1245/s10434-014-3754-y ◽

2014 ◽

Vol 21 (11) ◽

pp. 3661-3667 ◽

Cited By ~ 5

Author(s):

Jun Qian ◽

Juehua Jing ◽

Dasheng Tian ◽

Huilin Yang

Keyword(s):

Spinal Cord ◽

Multiple Myeloma ◽

Spinal Cord Compression ◽

Tumor Resection ◽

Cord Compression

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Giant Cervical Neurofibroma with Concomitant Deformity

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v23i4.1225 ◽

2018 ◽

Vol 23 (4) ◽

pp. 323-327

Author(s):

Gleidson C. Rodrigues ◽

Andrei F. Joaquim ◽

Enrico Ghizoni ◽

Luciano Queiróz ◽

Helder Tedeschi

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Tumor Resection ◽

Deformity Correction ◽

Cord Compression ◽

Cervical Kyphosis

A 27 years-old woman presenting with a giant cervical neurofibroma with spinal cord compression and cervical kyphosis is reported. We discuss the surgical nuances of the multiple surgeries required to achieve a total tumor resection and deformity correction. An algorithm used in our institution to treat cervical kyphosis is also presented.

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Spinal Cord Compression: A Review of 70 Pediatric Patients

Pediatric Hematology and Oncology ◽

10.1080/08880010390220126 ◽

2003 ◽

Vol 20 (6) ◽

pp. 457-466 ◽

Cited By ~ 42

Author(s):

Daniel Pollono ◽

Silvia Tomarchia ◽

Ricardo Drut ◽

Osvaldo Ibañez ◽

Mario Ferreyra ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Pediatric Patients ◽

Cord Compression

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Ossification of the posterior longitudinal ligament at the craniocervical junction presenting with Brown-Séquard syndrome: A case report

Surgical Neurology International ◽

10.25259/sni_704_2021 ◽

2021 ◽

Vol 12 ◽

pp. 501

Author(s):

Valérie Nicole Elise Schuermans ◽

Jasper van Aalst ◽

Alida A. Postma ◽

Anouk Y. J. M. Smeets

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Case Reports ◽

Posterior Longitudinal Ligament ◽

Cord Compression ◽

Craniocervical Junction ◽

Canal Stenosis ◽

History Of ◽

Lumbar Spinal ◽

Brown Sequard Syndrome

Background: Several case reports about spinal cord compression due to hyperostosis at the craniocervical junction are available. However, compression at C1-C2 solely due to ossification of the posterior longitudinal ligament (OPLL) is rare. Case Description: A 50-year-old Asian male, with a history of lumbar spinal canal stenosis, presented with a progressive quadriparesis within 3 months. Imaging showed central OPLL at the C1-C2 level contributing to severe spinal cord compression. The patient improved neurologically after a C1-C2 laminectomy. Conclusion: A patient presented with a progressive Brown-Séquard syndrome due to OPLL at the craniocervical junction (C1-C2 level) and improved following a decompressive laminectomy.

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Spinal Cord Compression: A Review of 70 Pediatric Patients

Pediatric Hematology and Oncology ◽

10.1080/713842389 ◽

2003 ◽

Vol 20 (6) ◽

pp. 457-466 ◽

Cited By ~ 1

Author(s):

Daniel Pollono ◽

Silvia Tomarchia ◽

Ricardo Drut ◽

Osvaldo Ibañez ◽

Mario Ferreyra ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Pediatric Patients ◽

Cord Compression

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Treatment of Spinal Cord Compression by Epidural Malignancy in Childhood

Neurosurgery ◽

10.1227/00006123-199103000-00002 ◽

1991 ◽

Vol 28 (3) ◽

pp. 349-352 ◽

Cited By ~ 37

Author(s):

Corey Raffel ◽

Victoria C. D. Neave ◽

Sean Lavine ◽

Gordon J. McComb

Keyword(s):

Spinal Cord ◽

Radiation Therapy ◽

Adjuvant Therapy ◽

Spinal Cord Compression ◽

Spinal Canal ◽

Tumor Resection ◽

Cord Compression ◽

Decompressive Laminectomy ◽

Nonsurgical Patients ◽

Canal Encroachment

Abstract Epidural spinal cord compression by a malignant tumor is a rare occurrence in children. Both the tumors involved and the extent of involvement of the vertebral column are different in children and adults. Often, the epidural tumor in a child is identified before significant spinal canal compromise has occurred, and these children frequently can be managed by radiation therapy and/or chemotherapy. There is a group of children, however, who have severe spinal canal encroachment by a tumor, as evidenced by a near complete or complete block on myelography. In this study, we report a group of patients with severe spinal cord compression, as documented by imaging studies. We compared the results of a decompressive laminectomy and subtotal tumor resection followed by adjuvant therapy with the results obtained with radiation therapy and/or chemotherapy alone. Thirty-three patients met the criteria for inclusion in the study. Twenty-six were treated with a laminectomy and adjuvant therapy, and 7 were treated without surgical intervention. With surgical therapy, 25 of 26 epidurals were either improved or stable, whereas 4 of 7 nonsurgical patients deteriorated. Especially notable was a decrease in pain in the operative patients immediately after their procedure. There was no surgical mortality or morbidity. The results of this study indicate that children with severe spinal cord compression as evidenced by a near complete or complete block on myelography or filling of 50% or more of the spinal canal on magnetic resonance imaging are best treated by a combination of surgical decompression and tumor removal followed by adjuvant therapy.

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Surgical treatment of spinal cord compression in kidney cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1986.4.12.1851 ◽

1986 ◽

Vol 4 (12) ◽

pp. 1851-1856 ◽

Cited By ~ 69

Author(s):

N Sundaresan ◽

H Scher ◽

G V DiGiacinto ◽

A Yagoda ◽

W Whitmore ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Spinal Cord Compression ◽

Tumor Resection ◽

Spinal Metastases ◽

Cord Compression ◽

Spinal Angiography ◽

Aggressive Surgical Approach ◽

Hypervascular Tumors ◽

Angiography And Embolization

Forty-three patients with renal-cell carcinoma underwent treatment for spinal cord compression over a 7-year period. Of these, 32 patients underwent surgery, while 11 patients underwent radiation alone. Before operation, 25 patients had relapsed following prior radiation, while seven others received postoperative radiation. A more aggressive surgical approach, tailored to the site of compression within the spinal canal, was used with the majority undergoing gross total tumor resection by an anterior approach. Immediate stability of the spine was achieved with methyl-methacrylate reconstruction of the resected segments. Preoperative spinal angiography with embolization of hypervascular tumors was carried out in eight patients. Patient parameters in the surgical and irradiated groups were comparable, except that a greater proportion of the radiation alone group had more than one organ system involved (64% v 44%). The median survival of the surgically treated patients was 13 months, compared with 3 months for those treated by radiation alone. In addition, a greater proportion of the surgically treated patients were benefitted neurologically (70%) compared with those treated by radiation (45%). With the development of effective surgical treatment for spinal metastases, early consideration for surgical treatment (before radiation) should be considered in selected patients. Preoperative spinal angiography and embolization are recommended whenever feasible to minimize intraoperative blood loss.

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