Haddad Miramar, Rimawi Layan, Hussein Moaiad, Al-Mollah Mustafa, Maani Walid
Department of Neurosurgery, Jordan University Hospital Amman, Jordan.
Ann Med Surg (Lond). 2023 Dec 2;86(1):565-570. doi: 10.1097/MS9.0000000000001545. eCollection 2024 Jan.
Chordoma of the cervical spine is a rare condition associated with poor long-term outcomes. This is mainly attributed to its pathological involvement of vital structures such as the cervical roots and vertebral artery (VA). Although the most appropriate management in these cases is total en bloc excision, attaining complete resection is relatively challenging due to the vicinity of the critical anatomical structures mentioned above.
A 15-year-old female with middle cervical spine chordoma was treated by a multidisciplinary team involving neurosurgery and head and neck surgeons utilizing anterior and posterior approaches followed by high-beam X-ray radiotherapy. Histopathological examination matched the description of a chordoma. Fifteen years after the initial excision, the patient maintained her normal neurological function without local recurrence or metastasis.
The patient underwent surgery in two stages. A posterior approach for C3, C4, and C5 laminectomies was performed in the first stage, with the second stage involving head and neck surgery for complete resection of the tumor. The patient also underwent radiotherapy 3 months after surgery for a total duration of 1 month. The patient is currently 30 years old with no evidence of chordoma recurrence.
Patients afflicted with cervical chordomas often find themselves undergoing multiple operations due to high recurrence rates. Fortunately, the utilization of en bloc resection coupled with adjuvant radiotherapy presents a hopeful treatment modality that can serve to substantially reduce recurrence rates, increase survival rates, and ultimately enhance the quality of life.
颈椎脊索瘤是一种罕见疾病，长期预后较差。这主要归因于其对颈神经根和椎动脉等重要结构的病理侵犯。尽管这些病例最合适的治疗方法是整块切除，但由于上述关键解剖结构位置相邻，实现完全切除相对具有挑战性。
一名15岁患有颈椎中段脊索瘤的女性患者，由神经外科医生和头颈外科医生组成的多学科团队采用前后联合入路进行治疗，随后进行高剂量X线放疗。组织病理学检查符合脊索瘤的描述。初次切除术后15年，患者神经功能正常，无局部复发或转移。
患者分两阶段接受手术。第一阶段对C3、C4和C5进行后路椎板切除术，第二阶段由头颈外科进行肿瘤完全切除术。患者术后3个月还接受了为期1个月的放疗。患者目前30岁，无脊索瘤复发迹象。
由于复发率高，颈椎脊索瘤患者常常需要接受多次手术。幸运的是，采用整块切除联合辅助放疗是一种有希望的治疗方式，可大幅降低复发率，提高生存率，并最终改善生活质量。
