title: Painful osteolytic metastasis of the atlas: treatment with percutaneous vertebroplasty.
abstract: METHODS
  Technical note.
  
  
  OBJECTIVE
  To describe a technique for performing percutaneous vertebroplasty of C1 for treatment of osteolytic metastatic disease involving the lateral portions of the atlas in which precautions are taken to protect the vertebrobasilar arterial supply and a posterior access route is used for cement delivery.
  
  
  BACKGROUND
  Percutaneous vertebroplasty (PVP) has proved to be efficient for the treatment of painful osteolytic vertebral disease. Good clinical experience with this technique suggested its extension to stabilize a painful osteolytic lesion of the atlas.
  
  
  METHODS
  A patient with known parotid cancer presented with neck pain refractory to conservative treatment. On computed tomography, osteolytic destruction of the atlas that mainly involved the right lateral mass and surrounded the vertebral artery was found. On digital subtraction angiography, the lesion was shown to be highly vascularized and supplied mainly by direct branches of the ipsilateral vertebral artery. To avoid the risk of cement reflux from the tumor vascular bed to the involved vertebral artery, coil occlusion of the involved V3 segment was performed before vertebroplasty. Percutaneous vertebroplasty was then carried out using a percutaneous posteroanterior direction access route.
  
  
  RESULTS
  Satisfactory filling of the osteolytic lesion with cement was achieved radiologically. Three days after the intervention and at a 9-month follow-up examination, the patient was free of pain.
  
  
  CONCLUSIONS
  Vertebroplasty used to treat an osteolytic lesion of the atlas involving the lateral mass was performed by a posterior percutaneous approach. To prevent vertebrobasilar embolism, the involved vertebral artery was occluded before polymer injection.
authors.affiliation: Department of Radiology at the University Hospital of Geneva, Geneva, Switzerland. stephanwetzel@yahoo.de
authors.forename: Stephan G
authors.initials: SG
authors.lastname: Wetzel
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Martin
authors.forename: Thierry
authors.initials: T
authors.lastname: Somon
authors.forename: Kai
authors.initials: K
authors.lastname: Wilhelm
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Rufenacht
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D002277:Carcinoma / Q000150:complications*; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D019547:Neck Pain / Q000209:etiology; D010014:Osteolysis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D010307:Parotid Neoplasms / Q000150:complications*; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome