Department of Orthopedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
Neurosurgery. 2011 Dec;69(2 Suppl Operative):ons184-93; discussion ons193-4. doi: 10.1227/NEU.0b013e31821bc7f9.
Surgical treatment of C2 tumors remains challenging. Because of the deep location and unique anatomical complexity, anterior exposure in this region is considered difficult and dangerous, and few reports concerning anterior tumor resection and reconstruction exist.
To describe a technique of sequentially staged resection and 2-column reconstruction for C2 tumors through a combined anterior retropharyngeal-posterior approach.
Eleven patients with C2 tumors underwent sequentially staged tumor resection and 2-column reconstruction in our institute. Eight primary lesions and 3 metastases were involved. Tumor resections and anterior reconstructions with conventional constructs were accomplished by an anterior retropharyngeal approach, and occipitocervical fusions through posterior access were performed in the same anesthesia.
No operative mortality occurred in this series. All patients experienced pain relief and neurological improvement after surgery. Except for 1 incidence of screw pullout, which was corrected by revision surgery, solid fusion was achieved in all patients. A follow-up period of 12 to 37 months was available for this study. Two patients with chordoma relapsed; 1 died of disease, and the other was alive with disease. Two patients with metastasis died of multiple remote metastases. No evidence of local recurrence was found in the other patients.
The anterior retropharyngeal approach is a favorable route to treat tumor lesions of the C2 vertebral body that allows tumor resection and placement of anterior constructs between C1 and the subaxial vertebral body. Tumor resection and 2-column reconstruction could safely be accomplished simultaneously through the combined anterior retropharyngeal-posterior approach.
C2 肿瘤的外科治疗仍然具有挑战性。由于位置深且解剖结构独特，该区域的前路暴露被认为是困难且危险的，因此很少有关于前路肿瘤切除和重建的报道。
描述一种通过前后联合入路序贯分期切除和 2 柱重建治疗 C2 肿瘤的技术。
本研究纳入 11 例 C2 肿瘤患者，通过前后联合入路序贯分期切除肿瘤和 2 柱重建。涉及 8 个原发性病变和 3 个转移灶。前路经咽后入路完成肿瘤切除和常规结构的前路重建，同期全麻下后路行枕颈融合。
本组无手术死亡病例。所有患者术后疼痛缓解，神经功能改善。除 1 例螺钉拔出，经翻修手术纠正外，所有患者均获得牢固融合。本研究随访 12 至 37 个月。2 例脊索瘤复发，1 例死亡，另 1 例带瘤生存。2 例转移瘤患者死于多发远处转移。其余患者无局部复发证据。
咽后前路是治疗 C2 椎体肿瘤的良好入路，可以切除肿瘤并在 C1 和下位颈椎体之间放置前路结构。通过前后联合入路可安全地同时完成肿瘤切除和 2 柱重建。
