Treatment of primary upper cervical tumors：21 cases report

English Keywords:Upper cervical spine  Spinal neoplasm  Surgical treatment

English Abstract:

  【Abstract】 Objective：To investigate the appropriate surgical strategy for primary upper cervical tumors. Method：From January 2001 to November 2006，a total of 21 cases（12 males and 9 females） with the average age at admission of 37.2 years old（range，12-64 years old） were reviewed retrospectively.The pathological diagnosis was chordoma in 12 cases，giant cell tumor in 7，chondrosarcoma in 1 and malignant schwannoma in 1.At diagnosis，12 cases had neck pain，11 had neck restriction，10 had neurological deficit and 1 had throat pain.19 had extra-compartment lesions and 14 had both the anterior and posterior element involved.The surgical approach was determined according to the tumor site.3 cases refused to operation and accepted radiotherapy due to financial cost，another 18 had surgery which included combined anterior and posterior approaches in 17 cases due to three columns or posterior soft tissue involved and posterior approach in 1 case due to posterior elements alone involved.All cases underwent complete tumor resection and 9 cases had adjuvant pre and post surgery radiotherapy，1 case with giant cell tumor underwent treatment of interferon.4 cases had unilateral vertebral arteries legated without any postoperative symptoms.Result：The average survivor for cases without operation was 3 months.While for cases accepting operation，1 died of respiratory failure postoperatively，the other 17 cases underwent surgery successfully.Preoperative symptoms relieved in 13 cases and remained no change in 2 cases.2 cases suffered transient quadriplegia which recovered 3 month later.2 cases had retropharyngeal wound dehiscence，one underwent debridement，while the other accepted no treatment due to no infection and no symptom despite of internal fixation exposure.15 cases had an average of 37.2 months follow-up and the other 2 cases were lost.At final follow-up，4 cases were alive with no tumor，8 cases died of local recurrence，3 cases were alive with local recurrence.Conclusion：Primary upper cervical malignant tumors often infiltrate extensively at diagnosis. Surgical approach should be determined based on tumor site to avoid high recurrence.