[Skull-base plasmacytoma with craniocervical instability].
BACKGROUND
Cranio-cervical instability is, in some cases, the main surgical concern in posterior skull base tumors. We report on a case in which a solitary plasmacytoma of the skull base presented with cranio-cervical instability. Vertebral artery was injured during surgery. The surgical anatomy is reviewed, with emphasis in vascular complications avoidance.


METHODS
A 66 year-old woman was diagnosed of a cranial base solitary plasmacytoma and treated with radio and chemotherapy with complete remission. After receiving that treatment, she presented with tetraparesis and a cranio-cervical instability was diagnosed. She was operated on, under cranial traction, of posterior occipito-cervical instrumentation with C1 to C2 transarticular Magerl screws. The right vertebral artery was injured during surgery without additional neurological deficit. Two years after the operation she remains independent for daily activities.


CONCLUSIONS
Transarticular screws at the C1 to C2 level of the cervical spine may provide rigid fixation in posterior cranio-cervical instrumentation for osteolytic lesions, but there is a risk of injury to the vertebral artery, specially when some variations in the surgical anatomy exist.
Samprón
N
N
Servicio de Neurocirugía. Hospital Donostia. San Sebastián. España.
Arrazola
M
M
Urculo
E
E
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001269:Atlanto-Occipital Joint / Q000473:pathology* / Q000601:surgery; D001270:Cervical Atlas / Q000601:surgery; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007593:Joint Instability / Q000209:etiology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D020953:Neuroaspergillosis / Q000188:drug therapy / Q000209:etiology; D009777:Occipital Bone / Q000473:pathology* / Q000601:surgery; D010014:Osteolysis / Q000209:etiology*; D010954:Plasmacytoma / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D011183:Postoperative Complications / Q000188:drug therapy; D055732:Pulmonary Aspergillosis / Q000188:drug therapy / Q000209:etiology; D011782:Quadriplegia / Q000209:etiology*; D012074:Remission Induction; D019292:Skull Base Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D014750:Vincristine / Q000008:administration & dosage
D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin