Resection of tumors at lateral mass of the atlas through a combined sub-mammillary process and sub-lower mandible approach.

Abstract

Objective To investigate procedure and therapeutic effect of combined sub-mamillary process and sub-lower mandible approach for resection of tumors at lateral mass of the atlas.Methods Eight patients with neoplasm at lateral mass of the atlas were surgitally treated by combined sub-mamillary process and sub-lower mandible approach.Tumor lesions involved in left lateral mass for 6 cages and in right for 2 cases.Pathological type of tumors included osteochondroma in 3 cases,osteoblastoma,giant cell tumor,plasmocytoma,chondrosarcoma and eosinophilic granuloma in 1 case respectively.All patients underwent occipitocervical fusion through posterior approach after tumor resection.Patients with plasmocytoma,giant cell tumor or chondrosarcoma received radiotherapy after surgery.Results This combined approach bought a good surgical field exposure so that tumor resection was performed successfully without vertebral artery and nerve jniury nor infection.Postoperative outcomes were satisfactory in all patients,with pain at the occiput and discomfort in pharyngeal portion alleviated.At the follow-up of 8-72 months,1 patient with chondrosarcoma recurred locally 14 months after operation and died of respiratory and circulation failure in 39 months after operation.No evidence of local recurrence was found in other patients.Conclusion Comparing with other approaches reported previously,the combined sub-mamillary process and sub-lower mandible approach is an ideal approach for the treatment of tumor lesions at lateral mass of the atlas.through which a wide exposure with well protect of vertebral artery benefiting to radical excision could be obmined without complications related to trans-oral surgery. Key words: Atlas; Bone neoplasms; Treatment outcome