title: En bloc resection of a C2-C3 upper cervical chordoma: Technical note.
abstract: BACKGROUND
  Recently, en bloc spondylectomy for upper cervical chordomas has been reported. Most authors utilize the combined approaches (e.g., transoral tumor resection with anterior column reconstruction and primary pharyngeal closure without up-front flap repair). However, the 60% incidence of posterior pharyngeal wall dehiscence delays oral intake, typically requires an additional surgery (e.g. free-flap), and delays radiation therapy.
  
  
  METHODS
  Here, we demonstrate the efficacy of en bloc C2-C3 spondylectomy for the treatment of upper cervical chordomas utilizing a combined transoral followed by posterior approach. We used a novel anterior de-epithelialized submental island flap (SIF) as an underlay graft between the pharyngeal wall and cage/hardware to prevent pharyngeal wound dehiscence.
  
  
  RESULTS
  Despite a small pharyngeal fistula, the construct healed and the patient was disease-free 40 months later.
  
  
  CONCLUSIONS
  En bloc C2-C3 spondylectomy for the treatment of an upper cervical chordoma typically requires a combined transoral and posterior approaches. This required utilization of an anterior SIF to promote adequate wound healing. This maneuver avoided incurring the typical complications of combined approaches (e.g. transoral tumor resection with anterior column reconstruction and primary pharyngeal closure without up-front flap repair).
authors.affiliation: Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Québec, Canada.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Weil
authors.affiliation: Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Québec, Canada.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Shehadeh
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Québec, Canada.
authors.forename: Tareck
authors.initials: T
authors.lastname: Ayad
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Québec, Canada.
authors.forename: Olivier
authors.initials: O
authors.lastname: Abboud
authors.affiliation: Division of Neurosurgery, Hôpital Notre-Dame du CHUM, University of Montreal, Montreal, Québec, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shedid
keywords: Chordoma; en bloc; oncology; spine; submental island flap