title: Chordomas of the upper cervical spine: clinical characteristics and surgical management of a series of 21 patients.
abstract: BACKGROUND
  Chordomas of the upper cervical spine are rare and present unique surgical challenge. This study aimed to describe the clinical characteristics and surgical management of patients with chordomas of the upper cervical spine.
  
  
  METHODS
  Twenty-one patients with chordomas of the upper cervical spine who were treated in Peking University Third Hospital from January 1999 to October 2012 were retrospectively analyzed. Survival was calculated by the Kaplan-Meier method and was compared between groups using the log-rank test.
  
  
  RESULTS
  The postoperative diagnosis was classical chordoma in 20 cases and chondroid chordoma in one case. The mean operative time was 9.5 hours (range 6-17 hours), and the mean blood loss was 2 812 ml (range 700-4 800 ml). There were two postoperative deaths. Unilateral vertebral artery ligation was performed in six patients, cervical nerve roots were cut in six patients, and the external branch of the superior laryngeal nerve was repaired after being cut in one case. Two patients developed postoperative velopharyngeal incompetence, and loosening of the occipitocervical screws was observed in one patient. The recurrence rate was 66.7% (10/15) after a mean follow-up period of 46.8 months (range 14-150 months). The 5- and 10- year overall survival rates were (39.8±13.1)% and (31.9±12.7)%, respectively. There was a significant difference in survival rate between patients who underwent surgery and those who did not.
  
  
  CONCLUSIONS
  In spite of the high rates of recurrence and complications after surgical treatment of chordomas of the upper cervical spine, intralesional resection combined with adjuvant radiotherapy remains the optimal treatment to prolong survival.
authors.affiliation: Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Diseases, Beijing 100191, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Diseases, Beijing 100191, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Diseases, Beijing 100191, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Wei
authors.affiliation: Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Diseases, Beijing 100191, China.
authors.forename: Miao
authors.initials: M
authors.lastname: Yu
authors.affiliation: Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Diseases, Beijing 100191, China.
authors.forename: Fengliang
authors.initials: F
authors.lastname: Wu
authors.affiliation: Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Diseases, Beijing 100191, China.
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Diseases, Beijing 100191, China. Email: liuzj@medmail.com.cn.
authors.forename: Zhongjun
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Diseases, Beijing 100191, China.
authors.forename: Gengting
authors.initials: G
authors.lastname: Dang
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D002817:Chordoma / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome