title: Operative technique for en bloc resection of upper cervical chordomas: extended transoral transmandibular approach and multilevel reconstruction.
abstract: Anterior exposure for cervical chordomas remains challenging because of the anatomical complexities and the restoration of the dimensional balance of the atlanto-axial region. In this report, we describe and analyze the transmandibular transoral approach and multilevel spinal reconstruction for upper cervical chordomas. We report two cases of cervical chordomas (C2 and C2-C4) that were treated by marginal en bloc resection with a transmandibular approach and anterior-posterior multilevel spinal reconstruction/fixation. Both patients showed clinical improvement. Postoperative imaging was negative for any residual tumor and revealed adequate reconstruction and stabilization. Marginal resection requires more extensive exposure to allow the surgeon access to the entire pathology, as an inadequate tumor margin is the main factor that negatively affects the prognosis. Anterior and posterior reconstruction provides a rigid reconstruction that protects the medulla and decreases axial pain by properly stabilizing the cervical spine.
authors.affiliation: Department of Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico.
authors.forename: Luis Alberto
authors.initials: LA
authors.lastname: Ortega-Porcayo
authors.affiliation: Department of Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico.
authors.forename: Eibar Ernesto
authors.initials: EE
authors.lastname: Cabrera-Aldana
authors.affiliation: Department of Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico.
authors.forename: Nicasio
authors.initials: N
authors.lastname: Arriada-Mendicoa
authors.affiliation: Department of Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Gómez-Amador
authors.affiliation: Department of Head and Neck Tumors, National Cancer Institute of Mexico, Mexico.
authors.forename: Martín
authors.initials: M
authors.lastname: Granados-García
authors.affiliation: Department of Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico.
authors.forename: Juan
authors.initials: J
authors.lastname: Barges-Coll
keywords: Chordoma; Neurosurgical instrumentation; Spinal neoplasms; Transmandibular approach