title: Anterior Spinal Reconstruction to the Clivus Using an Expandable Cage After C2 Chordoma Resection Via a Labiomandibular Glossotomy Approach: A Technical Report.
abstract: BACKGROUND
  En bloc resection of high-cervical chordomas is a technically challenging procedure associated with significant morbidity. Two key components of this procedure include the approach and the method of spinal reconstruction. A limited number of reported cases of en bloc resection of high-cervical chordomas have been reported in the literature.
  
  
  METHODS
  We report a novel case using an expandable cage to reconstruct the anterior spinal column above C2 with fixation to the clivus. We also report a novel anterior approach to the high-cervical spine via a midline labiomandibular glossotomy. We detail the management of complications related to 2 instances of wound dehiscence and hardware exposure requiring two additional operations. The final surgical procedure involved explantation of the anterior cervical plate and use of a vascularized radial graft to close the posterior pharyngeal defect and protect the hardware. At 26-month follow-up, the patient remained disease free without any neurologic deficit.
  
  
  CONCLUSIONS
  We report the novel use of the midline labiomandibular glossotomy for surgical approach and reconstruction of the anterior column to the clivus with an expandable cage. The unique features of this operative strategy allowed the surgical team to tailor the construct intraoperatively, resulting in solid arthrodesis without significant neurologic sequelae.
  
  
  CONCLUSIONS
  Labiomandibular glossotomy for approach to high anterior cervical chordomas followed by craniospinal reconstruction to the clivus with an expandable cage represents a novel technique for managing high cervical chordomas.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Alp
authors.initials: A
authors.lastname: Ozpinar
authors.affiliation: Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Liu
authors.affiliation: Inland Neurosugery and Spine Associates, Spokane, Washington, USA.
authors.forename: Nathaniel L
authors.initials: NL
authors.lastname: Whitney
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Tempel
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Choi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Andersen
authors.affiliation: Cape Cod Healthcare, Hyannis, Massachusetts, USA.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Coppa
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Electronic address: hamiltondk@upmc.edu.
authors.forename: D Kojo
authors.initials: DK
authors.lastname: Hamilton
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D002817:Chordoma / Q000000981:diagnostic imaging / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008046:Lip / Q000601:surgery; D008334:Mandible / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D014059:Tongue / Q000601:surgery
keywords: Anterior spinal reconstruction; Chordoma; Expandable cage construct; Labiomandibular glossotomy