Occipito-cervical fusion following gross total resection for the treatment of spinal extramedullary tumors in craniocervical junction: a retrospective case series

World Journal of Surgical Oncology

Zengming Xiao¹  Shaohui Zong¹  Maolin He¹  Xinli Zhan¹  Juliang He¹  Hua Jiang¹ 

[1] Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Nanning 530021, China

关键词: Occipito-cervical fusion;    Intraspinal tumor;    Extramedullary tumor;    Craniocervical junction;   

Others  :  1225470
DOI  :  10.1186/s12957-015-0689-0

 received in 2015-03-25, accepted in 2015-09-07,  发布年份 2015

【 摘 要 】

Background

Previous studies found that the facet joint of the C1 vertebra were removed (C1 facetectomy) before extirpation from the extramedullary tumor in craniocervical junction, leading to postoperative upper cervical instability or deformity. Occipito-cervical fusion (OCF) is a demanding and morbid surgical procedure, which can be used in such patients. This study is to analyze the clinical manifestation and surgical outcome of patients with craniocervical extramedullary tumor undergoing an extirpation of spinal tumors and OCF by one-stage posterior approach.

Methods

The surgical and clinical databases were searched for operative procedures that had been performed for patients with spinal extramedullary tumors in craniocervical junction at a single institution from January 2008 to July 2011. The following inclusion criteria were applied: (1) initial surgery for craniocervical extramedullary tumor, (2) gross total resection and occipito-cervical fusion had been performed, (3) minimum 2-year follow-up, and (4) no previous cervical spine surgery. Medical records included demographic characteristics, clinical assessment, and radiographic studies. Clinical outcomes before and after the surgery were assessed using Frankel grade and the Japanese Orthopaedic Association (JOA) score. Cervical sagittal alignment was evaluated by C0-2 angle and C2-7 angle based on X-ray.

Results

Nine patients were included in the study. Five patients had schwannoma, three patients had meningioma, and only one patient had neurofibroma. All cases were followed up for 24–42 months (average, 34.2 months). At the last follow-up, three patients improved from Frankel grade C to grade D, two patients from Frankel grade C to grade E, and one patient from Frankel grade D to grade E, while two patients remained stationary at the Frankel grade D. The JOA score of the eight patients were 9.0 (range, 6–17) before surgery and were 14.6 (range, 12–17) at the most recent follow-up (p < 0.05). The mean C0-2 angle and the mean C2-7 angle before surgery were 26.2 ± 5.3° and 17.4 ± 13.1°, respectively. At the end of follow-up, the mean C0-2 angle was 25.6 ± 4.8°, and the mean C2-7 angle decreased to 12.7 ± 10.9°. However, this trend did not reach statistical significance (p < 0.05). Two patients suffered from cerebrospinal fluid leaks postoperatively. All patients had a satisfactory fusion and did not exhibit a tumor recurrence during the follow-up period.

Conclusions

OCF following gross total resection appears to be a useful surgical procedure for the craniocervical extramedullary tumors requiring C1 facetectomy and does not cause postoperative kyphosis of the upper cervical spine.

【 授权许可】

   
2015 Jiang et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Cohen-Gadol AA, Zikel OM, Koch CA, Scheithauer BW, Krauss WE. Spinal meningiomas in patients younger than 50 years of age: a 21-year experience. J Neurosurg. 2003; 98:258-263.
• [2]Gottfried ON, Gluf W, Quinones-Hinojosa A, Kan P, Schmidt MH. Spinal meningiomas: surgical management and outcome. Neurosurg Focus. 2003; 14: Article ID e2
• [3]Jenkinson MD, Simpson C, Nicholas RS, Miles J, Findlay GF, Pigott TJ. Outcome predictors and complications in the management of intradural spinal tumours. Eur Spine J. 2006; 15:203-210.
• [4]Parlato C, Tessitore E, Schonauer C, Moraci A. Management of benign craniovertebral junction tumors. Acta Neurochir (Wien). 2003; 145:31-36.
• [5]Nanda A, Kukreja S, Ambekar S, Bollam P, Sin AH. Surgical strategies in the management of spinal nerve sheath tumors. World Neurosurg. 2015; 83:886-899.
• [6]Bydon M, Ma TM, Xu R, Weingart J, Olivi A, Gokaslan ZL, Tamargo RJ, Brem H, Bydon A. Surgical outcomes of craniocervial junction meningiomas: a series of 22 consecutive patients. Clin Neurol Neurosurg. 2014; 117:71-79.
• [7]Sciubba DM, Chaichana KL, Woodworth GF, McGirt MJ, Gokaslan ZL, Jallo GI. Factors associated with cervical instability requiring fusion after cervical laminectomy for intradural tumor resection. J Neurosurg Spine. 2008; 8:413-419.
• [8]McGirt MJ, Chaichana KL, Atiba A, Bydon A, Witham TF, Yao KC, Jallo GI. Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty. J Neurosurg Pediatr. 2008; 1:57-62.
• [9]Ikuma H, Shinohara K, Maehara T, Yokoyama Y, Tanaka M. C2 lamina reconstruction using locking miniplate for the intradural tumor of the craniocervical junction (two case reports). Eur Spine J. 2012; 21 Suppl 4:S509-512.
• [10]Abumi K, Takada T, Shono Y, Kaneda K, Fujiya M. Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. Spine (Phila Pa 1976). 1999; 24:1425-1434.
• [11]Ogihara N, Takahashi J, Hirabayashi H, Hashidate H, Kato H. Long-term results of computer-assisted posterior occipitocervical reconstruction. World Neurosurg. 2010; 73:722-728.
• [12]Mehta AI, Adogwa O, Karikari IO, Thompson P, Verla T, Null UT, Friedman AH, Cheng JS, Bagley CA, Isaacs RE. Anatomical location dictating major surgical complications for intradural extramedullary spinal tumors: a 10-year single-institutional experience. J Neurosurg Spine. 2013; 19:701-707.
• [13]Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine (Phila Pa 1976). 1986; 11:521-524.
• [14]Lee SH, Kim KT, Seo EM, Suk KS, Kwack YH, Son ES. The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults. J Spinal Disord Tech. 2012; 25:E41-47.
• [15]Vender JR, Houle PJ, Harrison S, McDonnell DE. Occipital-cervical fusion using the Locksley intersegmental tie bar technique: long-term experience with 19 patients. Spine J. 2002; 2:134-141.
• [16]Slin'ko EI, Al Q. Intradural ventral and ventrolateral tumors of the spinal cord: surgical treatment and results. Neurosurg Focus. 2004; 17:ECP2.
• [17]Crockard HA, Sen CN. The transoral approach for the management of intradural lesions at the craniovertebral junction: review of 7 cases. Neurosurgery. 1991; 28:88-97.
• [18]Das KK, Kumar R, Ashish K, Bettaswamy G, Mehrotra A, Jaiswal S, Sahu RN, Jaiswal AK, Behari S. Extramedullary foramen magnum tumors and their surgical management: an experience with 29 cases. Asian J Neurosurg. 2014; 9:223-232.
• [19]Yasuda M, Bresson D, Cornelius JF, George B. Anterolateral approach without fixation for resection of an intradural schwannoma of the cervical spinal canal: technical note. Neurosurgery. 2009; 65:1178-1181.
• [20]Mei-Hua L, Geng-Sheng X, Zhi-Qun J, Yi-Yun L, Tao H. Supracondylar transjugular tubercle approach to intradural lesions anterior or anterolateral to the craniocervical junction without resection of the occipital condyle. Turk Neurosurg. 2013; 23:202-207.
• [21]Fong S, DuPlessis SJ. Minimally invasive anterior approach to upper cervical spine: surgical technique. J Spinal Disord Tech. 2005; 18:321-325.
• [22]Bydon M, Gokaslan ZL. The three-dimensional endoscopic far-lateral approach: many dimensions to the craniocervical junction with a far-from-average operation. World Neurosurg. 2014; 82:e709-710.
• [23]Eicker SO, Mende KC, Duhrsen L, Schmidt NO. Minimally invasive approach for small ventrally located intradural lesions of the craniovertebral junction. Neurosurg Focus. 2015; 38: Article ID E10
• [24]Ahn DK, Park HS, Choi DJ, Kim KS, Kim TW, Park SY. The surgical treatment for spinal intradural extramedullary tumors. Clin Orthop Surg. 2009; 1:165-172.
• [25]Angevine PD, Kellner C, Haque RM, McCormick PC. Surgical management of ventral intradural spinal lesions. J Neurosurg Spine. 2011; 15:28-37.
• [26]Deutsch H, Haid RW, Rodts GE, Mummaneni PV. Occipitocervical fixation: long-term results. Spine (Phila Pa 1976). 2005; 30:530-535.
• [27]Song KW, Shin SI, Lee JY, Kim GL, Hyun YS, Park DY. Surgical results of intradural extramedullary tumors. Clin Orthop Surg. 2009; 1:74-80.
• [28]Zdeblick TA, Zou D, Warden KE, McCabe R, Kunz D, Vanderby R. Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg Am. 1992; 74:22-27.
• [29]Raynor RB, Pugh J, Shapiro I. Cervical facetectomy and its effect on spine strength. J Neurosurg. 1985; 63:278-282.
• [30]Fassett DR, Clark R, Brockmeyer DL, Schmidt MH. Cervical spine deformity associated with resection of spinal cord tumors. Neurosurg Focus. 2006; 20: Article ID E2
• [31]Winegar CD, Lawrence JP, Friel BC, Fernandez C, Hong J, Maltenfort M, Anderson PA, Vaccaro AR. A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine. 2010; 13:5-16.
• [32]Bhatia R, Desouza RM, Bull J, Casey AT. Rigid occipitocervical fixation: indications, outcomes, and complications in the modern era. J Neurosurg Spine. 2013; 18:333-339.