title: Cervicothoracic giant cell tumor expanding into the superior mediastinum: total excision by combined anterior-posterior approach.
abstract: This article describes a case of cervicothoracic giant cell tumor expanding into the superior mediastinum treated by total spondylectomy. A 42-year-old-man presented with back pain and paraparesis. Magnetic resonance imaging revealed the collapse of the T2 vertebral body. The spinal cord was severely compressed by the tumor mass. The tumor had spread from T2 to the mediastinum, so that the tumor was in contact with many vital structures. To resect the tumor completely, total spondylectomy from T1 to T3 was performed through a combined anterior-posterior approach. The tumor was dissected from the vital structures using an anterior low cervical approach and splitting one-third of the sternum. En bloc vertebral resection from Th1 to Th3, including the tumor pseudocapsule, was possible through a posterior approach. The tumor around the nerve roots or dura was resected piece by piece since it was possible to separate the capsulated tumor from the dura. Splitting one-third of the sternum allowed separation of the tumor from the anterior vital structures, under direct vision. This allowed en bloc vertebral resection of the tumor that had spread to the mediastinum from T2 and in the craniocaudal direction from T1 to T3. Although giant cell tumor is benign, it can be locally aggressive. Complete excision of a giant cell tumor is the best treatment option even for the cervicothoracic spine, to protect the vital structures or neural function.
authors.affiliation: Department of Orthopedic Surgery, School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, Japan.
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Norio
authors.initials: N
authors.lastname: Kawahara
authors.forename: Hideki
authors.initials: H
authors.lastname: Murakami
authors.forename: Satoru
authors.initials: S
authors.lastname: Demura
authors.forename: Masahito
authors.initials: M
authors.lastname: Kawaguchi
authors.forename: Makoto
authors.initials: M
authors.lastname: Oda
authors.forename: Isao
authors.initials: I
authors.lastname: Matsumoto
authors.forename: Katsuro
authors.initials: K
authors.lastname: Tomita
mesh_terms: D000328:Adult; D005870:Giant Cell Tumors / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome