Onoki Takahiro, Hashimoto Ko, Takahashi Kohei, Yahata Ken-Ichiro, Kusakabe Junya, Kawaharada Tomonori, Kanno Haruo, Aizawa Toshimi
Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan.
Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan.
J Neurosurg Case Lessons. 2025 Jul 28;10(4). doi: 10.3171/CASE25241.
Chordomas of the upper cervical spine are rare. Recently, a relatively good long-term prognosis was reported for ion-beam radiotherapy. However, in a few cases, the tumor showed regrowth after radiotherapy. Resection is the treatment of choice in such cases, and spine surgery following ion-beam radiotherapy is associated with multiple complications. Here, the authors present a unique case of a C2 chordoma that showed regrowth after ion-beam radiotherapy.
A 49-year-old man was diagnosed with a C2 chordoma and treated with ion-beam radiotherapy and posterior occipitocervical fusion. Five years later, the tumor showed regrowth, and complete macroscopic resection was successfully performed through mandibular splitting and the transoral approach under O-arm navigation assistance. However, wound healing of the posterior pharyngeal wall was unfavorable, and plastic surgeons created an osteocutaneous radial forearm free flap. Four years after surgery, no obvious local recurrence was observed.
This case highlights a unique scenario in which chordoma regrowth occurs after ion-beam radiotherapy. An anterior approach and complete tumor removal may result in a good outcome, but the surgical incision close to the irradiated field may fail to fuse. Therefore, spine surgeons and plastic surgeons should closely coordinate for proper wound closure in patients after ion-beam radiotherapy. https://thejns.org/doi/10.3171/CASE25241.
上颈椎脊索瘤较为罕见。近期有报道称离子束放射治疗具有相对较好的长期预后。然而，在少数病例中，肿瘤在放疗后出现复发。在这种情况下，手术切除是首选治疗方法，而离子束放疗后的脊柱手术会伴有多种并发症。在此，作者呈现了一例C2脊索瘤在离子束放疗后复发的独特病例。
一名49岁男性被诊断为C2脊索瘤，并接受了离子束放疗和枕颈后路融合术。五年后，肿瘤复发，在O型臂导航辅助下，通过下颌骨劈开和经口入路成功进行了肿瘤全切除。然而，咽后壁伤口愈合不佳，整形外科医生制作了桡骨前臂游离骨皮瓣。术后四年，未观察到明显的局部复发。
该病例凸显了离子束放疗后脊索瘤复发的独特情况。前路手术和肿瘤全切可能会带来良好的预后，但靠近放疗区域的手术切口可能无法愈合。因此，脊柱外科医生和整形外科医生应密切协作，以确保离子束放疗后患者伤口的妥善闭合。https://thejns.org/doi/10.3171/CASE25241 。
