Cervical paraspinal chordoma with left vertebral artery encasement

Chi-Man Yip,Hui-Hwa Tseng,Ping-Hong Lai,Shu-Shong Hsu

doi:10.5348/ijcri-2015112-cr-10573

Abstract

Introduction: chordomas are slow-growing, low-grade malignant but locally invasive tumors which originate from embryonic remnants of the primitive notochord. chordomas are principally midline tumors. In the neuraxis, chordomas are most commonly located in the sacrococcygeal region (50–55%), followed by the cranio-occipital region (25–30%). case report: A 71-year-old male has a left paraspinal tumor extending from c2 to c6 with bone erosion and left vertebral artery encasement. the tentative diagnosis before surgery was lymphoma or metastatic tumor. He underwent posterior cervical decompression with surgical debulking of the tumor to release the cord compression and posterior lamina screw fixation from c2 to c7 with allograft fusion and pathology confirmed the tumor to be chordoma. conclusion: Due to the rare occurrence of chordomas extra-axially, these lesions have not earned a great deal of consideration in the clinical and radiographic differential diagnoses

Highlights

Chordomas are slow-growing, low-grade malignant but locally invasive tumors which originate from embryonic remnants of the primitive notochord
An accurate preoperative diagnosis of chordoma is crucial, as survival is optimal when radical en bloc resection is performed at primary surgery
An accurate preoperative diagnosis of chordoma is crucial, as survival is optimal when radical en bloc resection is performed at primary surgery if possible [5, 8]

Summary

INTRODUCTION

Chordomas are slow-growing, low-grade malignant but locally invasive tumors which originate from embryonic remnants of the primitive notochord. A 71-year-old male having past medical history of hypertension, herb-related chronic renal insufficiency and Parkinsonism who presented to us in December 2014 with the chief complains of progressive weakness of four extremities and unsteady gait for more than one year On admission, he was conscious clear and his neurological examination revealed motor weakness of his bilateral upper limbs and bilateral lower limbs with muscle power grade 4; clumsy hands and unsteady gait; positive Hoffmann’s sign and Babinski’s sign on his left side; fine hand tremor; evident spasticity on his four limbs and rigidity on his upper limbs. Based on the imaging finding, lymphoma or metastatic tumor was the tentative diagnosis, but the tumor markers checked before operation were within normal limits. Under general anesthesia, this patient was put in prone position with his neck was in neutral position.

Findings

DISCUSSION

CONCLUSION