En Bloc Resection of Cervical Sarcoma Involving C1: Report of Two Cases and Surgical Considerations
|Deshdeepak Sahni1, Akaanksh Shetty1, Jeffrey T Vrabec1, Donald T. Donovan2 and Rex AW Marco1*|
|1Department of Orthopedic Surgery, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower, Suite 2600, Houston, USA|
|2Department of Otolaryngology, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower, Suite 1701, Houston, USA|
|Corresponding Author :||Rex A.W. Marco
Vice-Chair, Department of Orthopedic Surgery
Houston Methodist Hospital, 6550 Fannin Street
Smith Tower, Suite 2600, Houston, TX 77030, USA
E-mail: [email protected]
|Received: May 11, 2015; Accepted: June 27, 2015; Published: June 30, 2015|
|Citation: Sahni D, Shetty A, Vrabec JT, Donovan DT, Marco RAW (2015) En Bloc Resection of Cervical Sarcoma Involving C1: Report of Two Cases and Surgical Considerations. J Spine 4:232.doi:10.4172/2165-7939.1000232|
|Copyright: © 2015 Sahni D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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Study background: A two patient case series describing the surgical management of upper cervical sarcoma. Due to the density of critical neurovascular structures in the upper cervical spine, these rare sarcomas require primary surgical treatment that preempts local recurrence. Recurrence secondary to tumor spillage is problematic due to scar tissue formation and radiation effect creating surgically inaccessible tissue planes. En bloc resection of sarcomas during an index procedure provides the best chance at cure and prevention of local recurrence. Meticulous planning, familiarity with anatomy and surgical technique is critical for the success of these operations.
Methods: Two patients: a 30-year-old and 36-year-old female, were referred to our institution with malignant spine tumors involving C1. The first was found to have a left sided synovial sarcoma anterolateral to C1 and C2. The second presented with metastatic alveolar soft tissue sarcoma at C1. Both patients underwent multi-stage en bloc surgical removal of their tumors.
Results: Successful en bloc tumor excision and instrumented stabilization of the cervical spine without neurovascular complication was performed. Tumor margins were negative and x-rays demonstrated adequate spinal alignment. At six month followup, MRI evaluation demonstrated no local recurrence in either patient.
Conclusions: En bloc resection is a highly effective, but technically demanding method of treating upper cervical sarcomas. In conjunction with adjuvant radiotherapy, en bloc surgery has the lowest risk of local recurrence and highest quality of life outcomes. Due to the proximity of critical neurovascular structures in the upper cervical spine, meticulous planning, staging and technique is required. A multidisciplinary surgical team should be assembled that includes a head and neck, skull-base, neuro-endovascular and spine surgeon. With appropriate planning, understanding of anatomy and surgical technique, en bloc resections of upper cervical sarcomas can be successfully performed.