Anterior stabilization of the CI―CIII vertebrae after transoral removal of an aggressive aneurysmal bone cyst of the CII vertebra (a case report and literature review)

Shkarubo A.N.; Kuleshov A.A.; Chernov I.V.; Vetrile M.S.; Berchenko G.N.; Lisyanskiy I.N.; Makarov S.N.

doi:https://doi.org/10.17116/neiro201882051111

Shkarubo A.N.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Kuleshov A.A.

Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russia

Chernov I.V.

Sechenov First Moscow State Medical University, Moscow, Russia

Vetrile M.S.

Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russia

Berchenko G.N.

Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia

Lisyanskiy I.N.

Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia

Makarov S.N.

Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia

Anterior stabilization of the CI―CIII vertebrae after transoral removal of an aggressive aneurysmal bone cyst of the CII vertebra (a case report and literature review)

Authors:

Shkarubo A.N., Kuleshov A.A., Chernov I.V., Vetrile M.S., Berchenko G.N., Lisyanskiy I.N., Makarov S.N.

More about the authors

Journal: Burdenko's Journal of Neurosurgery. 2018;82(5): 111‑118

DOI: 10.17116/neiro201882051111

Read: 2315 times

To cite this article:

Shkarubo AN, Kuleshov AA, Chernov IV, Vetrile MS, Berchenko GN, Lisyanskiy IN, Makarov SN. Anterior stabilization of the CI―CIII vertebrae after transoral removal of an aggressive aneurysmal bone cyst of the CII vertebra (a case report and literature review). Burdenko's Journal of Neurosurgery. 2018;82(5):111‑118. (In Russ., In Engl.)
https://doi.org/10.17116/neiro201882051111

Подписка 2025 Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко (Burdenko's Journal of Neurosurgery)

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Abstract:

Treatment of patients with atlantoaxial instability caused by various diseases of the skull base and craniovertebral junction combined with ventral compression of the brainstem is a complex issue that is ambiguously resolved in different ways. We present a case of stepped treatment, the most important component of which was successful transoral removal of an aggressive aneurysmal bone cyst of the CII vertebra with anterior CI―CIII segment stabilization using an individual system, which was performed through the same approach. Clinical case. A 31-year-old male patient presented with destruction of the CII body and odontoid process affected by an aggressive aneurysmal bone cyst causing disintegration of the CII posterior wall and odontoid process, which clinically manifested by constricted motion and pain in the cervical spine. Results. Three-step surgical treatment was performed. First, we performed a puncture biopsy of the CII body through the submandibular approach as well as posterior occipitospondylodesis with metal instrumentation from the occipital bone level to the CIV vertebra. Two months later, the patient underwent transoral removal of the CII body and odontoid process lesion and anterior CI―CIII segment stabilization using an individual cover metal system through the same approach. Two weeks after the second intervention, the occipitospondylodesis was transformed to a posterior CI―CIII stabilization system. Control CT 8 months after surgery showed the correct position of both stabilization systems. Conclusion. The use of individual instrumentation for anterior stabilization of the CI―CIII vertebrae in various diseases of the craniovertebral junction area is an effective and promising technique.

Keywords:

transoral approach

anterior CI―CIII segment stabilization

aggressive aneurysmal cyst

Authors:

Shkarubo A.N.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Kuleshov A.A.

Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russia

Chernov I.V.

Sechenov First Moscow State Medical University, Moscow, Russia

Vetrile M.S.

Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russia

Berchenko G.N.

Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia

Lisyanskiy I.N.

Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia

Makarov S.N.

Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia

Close metadata

References:

Dorfman HD, Czerniak B., Aneurysmal Bone Cyst. In: Bone tumors. Mosby, Inc. 1998;855‒879.
Barbanti-Brodano G, Girolami M, Ghermandi R, Terzi S, Gasbarrini A, Bandiera S, Boriani S. Aneurysmal bone cyst of the spine treated by concentrated bone marrow: clinical cases and review of the literature. Eur Spine J. 2017 Feb 6. https://doi.org/10.1007/s00586-017-4978-x
Diseases of the osteoarticular system. Pathology (guideline). Eds. Berchenko GN, Paltsev MA, Paukov MS, Ulumbekov EG. M.: GEOTAR-Media; 2002:565-597.
Boriani S, De Iure F, Campanacci L, Gasbarrini A, Bandiera S, Biagini R, Bertoni F, Picci P. Aneurysmal bone cyst of the mobile spine: report on 41 cases. Spine. 2001;26:27-35. https://doi.org/10.1097/00007632-200101010-00007
Capanna R, Albisinni U, Picci P, Calderoni P, Campanacci M, and Springfield DS. Aneurysmal Bone Cyst of the Spine. The Journal of Bone and Joint Surgery. 1985 April;67:4:527-531. https://doi.org/10.2106/00004623-198567040-00004
De Kleuver M, van der Heul RO, Ben EE, Veraart MJ. Aneurysmal bone cyst of the spine. Journal of Pediatric Orthopaedics. 1998 October;7:4:286-292. https://doi.org/10.1097/01202412-199810000-00006
Shkarubo AN, Kuleshov AA, Semenova LA, Shishkina LV, Shvets VV, Vetrile MS, Gromov IS, Marshakov VV, Chernov IV. Surgical treatment of clival and axis bone cysts. Voprosy Neirokhirurgii imeni N.N. Burdenko. 2016;1(80):88-97. (In Russ) https://doi.org/10.17116/neiro201680188-97
Ai Fu-Zhi, Qing-Shui Yin, Da-Chuan Xu, Hong Xia, Zeng-Hui Wu, and Xiao-Hong Mai. Transoral Atlantoaxial Reduction Plate Internal Fixation with Transoral Transpedicular or Articular Mass Screw of C2 for the Treatment of Irreducible Atlantoaxial Dislocation. Spine. 2011 April;36(8):E556-E562. https://doi.org/10.1097/brs.0b013e3181f57191
Shkarubo AN, Kaznacheev VM, Fomin BV, Pakhomov GA, Bocharov OV, Bulanova VT. Transoral removal of chordoma of the skull base with advanced occipitoparietal. Neurosurgery. 2002;1:48-52.
Shkarubo AN, Kaznacheev VM, Fomin BV, Pakhomov GA. Russian Federation Patent for the invention №2173959. «Method of surgical treatment of diffusely growing tumors of the skull base with instability of the craniovertebral junction». Accessed 02.06.17. Available at: https://www.freepatent.ru/patents/2173959
Shkarubo AN, Kuleshov AA, Chernov IV, Vetrile MS. Transoral decompression and anterior stabilization of atlantoaxial joint in patients with basilar impression and chiari malformation type I: a technical report of 2 clinical cases. World Neurosurgery. 2017;102:181-190. https://doi.org/10.1016/j.wneu.2017.02.113
Shkarubo AN. Surgery of tumors of the skull base using transnasal and transoral approaches with endoscopic control (pituitary adenomas, craniopharyngiomas, chordomas): Dis. … doc. med. sci. M. 2007. (In Russ.)
Hadley MN, Spetzler RF, Sonntag VKH. The transoral approach to the superior cervical spine. J Neurosurgery. 1989;71:1:16-23. https://doi.org/10.3171/jns.1989.71.1.0016
Kandziora F, Mittlmeier T, Fridun K. Stage-related surgery for cervical spine instability in rheumatoid arthritis. European Spine J. 1999;8:5:371-381. https://doi.org/10.1007/s005860050190
Kerschbaumer F, Kandziora F, Klein C, Mittlmeier T, Starker M. Transoral decompression, anterior plate fixation, and posterior wire fusion for irreducible atlantoaxial kyphosis in rheumatoid arthritis. Spine. 2000;25:2708-2715. https://doi.org/10.1097/00007632-200010150-00029
Amelot A, Terrier L-M, Lot G. Craniovertebral junction transoral approach: predictive factors of complications. World Neurosurgery. 2018;110:568-574. https://doi.org/10.1016/j.wneu.2017.09.135
Goel A. Is atlantoaxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoaxial fixation. J Neurosurgery: Spine. 2015;22:2:116-127. https://doi.org/10.3171/2014.10.spine14176
Crockard HA, Johnston F. Development of transoral approaches to lesions of the skull base and craniocervical junction. Neurosurg Q. 1993;3:61-82.
Jain VK, Behari S, Banerji D, Bhargava V, Chhabra DK. Transoral decompression for craniovertebral osseous anomalies: perioperative management dilemmas. Neurol India. 1999;47(3):188-195.
Shkarubo AN, Kuleshov AA, Tetyukhin DV, Kolyadin VS, Chernov IV. Device for anterior stabilization of the C1—C3 vertebrae. RF patent for the invention №2615901. Accessed 02.06.17. Available at: https://www.findpatent.ru/patent/261/2615901.html
Berchenko GN. Diseases of locomotor apparatus. Pathological anatomy (National guideline). Eds. Paltseva MA, Kakturskogo LV, Zairatyantsa OV. M.: GEOTAR-Media; 2011:877-897. (In Russ.)
Nielsen GP, Fletcher JA, Oliveria AM. Aneurysmal bone cyst. In: WHO Classification of Tumours of Soft Tissue and Bone. Eds. Fletcher JA, Bridge JA, Hogendoorn FM. Lyon. 2013;348-349.
Saccomanni B. Aneurysmal bone cyst of spine: a review of literature. Archives of Orthopaedic and Trauma Surgery. 2007;128:10:1145-1147. https://doi.org/10.1007/s00402-007-0477-6
Rapp TB, Ward WP, Alaia MJ. Aneurysmal bone cyst. Journal of the American Academy of Orthopaedic Surgeons. 2012;20:4:233-241. https://doi.org/10.5435/jaaos-20-04-233
Goel A, Bhatjiwale M, Desai K. Basilar invagination: a study based on 190 surgically treated patients. Neurosurgical Focus. 1998;4:4:E1. https://doi.org/10.3171/foc.1998.4.4.1
Sawin PD, Menezes AH. Basilar invagination in osteogenesis imperfecta and related osteochondrodysplasias: medical and surgical management. J of Neurosurgery. 1997;86:6:950-960. https://doi.org/10.3171/jns.1997.86.6.0950
Dickman CA, Spetzler RF, Sonntag VK. Surgery of the craniovertebral junction. New York: Thieme, 1998.
Crockard HA. Anterior approaches to lesions of the upper cervical spine. Clin Neurosurg. 1988;34:389-416.
Di Lorenzo N. Craniocervical junction malformation treated by transoral approach. A survey of 25 cases with emphasis on postoperative instability and outcome. Acta Neurochirurgica. 1992;118:3-4:112-116. https://doi.org/10.1007/bf01401296
Xue-Shi Li, Zeng-Hui Wu, Hong Xia, Xiang-Yang Ma, Fu-Zhi Ai, I Kai Zhang, I Jian-Hua Wang, Xiao-Hong Mai, Qing-Shui Yin. The development and evaluation of individualized templates to assist transoral C2 articular mass or transpedicular screw placement in TARP-IV procedures: adult cadaver specimen study. Clinics (Sao Paulo). 2014;69(11):750-757. https://doi.org/10.6061/clinics/2014(11)08
Zhang Bao-cheng, Hai-bo Liu, Xian-hua Cai, Zhi-hua Wang, Feng Xu, Hui Kang, Ran Ding, Xiao-qing Luo. Biomechanical comparison of a novel transoral atlantoaxial anchored cage with established fixation technique — a finite element analysis. BMC Musculoskeletal Disorders. 2015;16(1). https://doi.org/10.1186/s12891-015-0662-7
Yin Qing Shui, Fu Zhi Ai, Kai Zhang, Yun Bing Chang, Hong Xia, Zeng Hui Wu, Ri Quan, Xiao Hong Mai, Jing Fa Liu. Irreducible anterior atlantoaxial dislocation. Spine. 2005;30(13):E375-E381. https://doi.org/10.1097/01.brs.0000168374.84757.d5
Kandziora F, Schulze-Stahl N, Khodadadyan-Klostermann C, Schröder R, Mittlmeier T. Screw placement in transoral atlantoaxial plating systems: an anatomical study. Journal of Neurosurgery: Spine. 2001;95(1):80-87. https://doi.org/10.3171/spi.2001.95.1.0080
Shkarubo AN, Kuleshov AA, Chernov IV, Vetrile MS, Lisyansky IN, Makarov SN, Ponomarenko GP, Spyrou M. Transoral secompression and stabilization of the upper cervical segments of the spine using custom-made implants in various pathologic conditions of the craniovertebral junction. World Neurosurg. 2018;109:e155-e163. https://doi.org/10.1016/j.wneu.2017.09.124
Štulík J, Kozák J, Šebesta P, Vyskočil T, Kryl J, Pelichovská M. Total spondylectomy of C2: a new surgical technique. Acta Chirurgiae Orthopaedicae Et Traumatologiae Čechosl. 2007;74:79-90.
Levin DA, Hensinger RN, Graziano GP. Aneurysmal bone cyst of the second cervical vertebrae causing multilevel upper cervical instability. Journal of Spinal Disorders and Techniques. 2006;19(1):73-75. https://doi.org/10.1097/01.bsd.0000172073.38814.f9
Galibert P, Deramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33:166-168.
Wang KW, Wang HK, Lu K, Liang CL, Chen Y1, Liliang PC. Fluoroscopically guided C2 percutaneous vertebroplasty: a surgical technique note on an anterior ascending approach. Pain Physician. 2016;19(4):E625-E629.
Brage Liberto, Héctor Roldán, Julio Plata-Bello, Diego Martel, and Víctor García-Marín. Transoral vertebroplasty for a C2 aneurysmal bone cyst. The Spine J. 2016;16(7):e473-e477. https://doi.org/10.1016/j.spinee.2016.02.042
Schmelzle R, Harms J, Stoltze D. Osteosynthesen im occipitocervicalem Übergang vom transoralen Zugang aus. XVII SICOT World Congress, Abstract book, 28, 1987.
Kandziora F, Kerschbaumer F, Starker M, Mittlmeier T. Biomechanical assessment of transoral plate fixation for atlantoaxial instability. Spine. 2000;25(12):1555-1561. https://doi.org/10.1097/00007632-200006150-00016
Kerschbaumer F, Kandziora F, Ewald W, et al. Staged therapy for atlantoaxial instability in rheumatoid arthritis. J Bone Joint Surg (Br). 1998 (Abstract);80:S244-S245.
Brooks AL, Jenkins EB. Atlanto-axial arthrodesis by the wedge compression method. The Journal of Bone & Joint Surgery. 1978 April;60(3):279284. https://doi.org/10.2106/00004623-197860030-00001
Polli FM, Miscusi M, Forcato S, Raco A. Atlantoaxial anterior transarticular screw fixation: a case series and reappraisal of the technique. The Spine J. 2015;15(1):185-193. https://doi.org/10.1016/j.spinee.2014.09.019
Hu Yong, Wei-xin Dong, Kepler CK, Zhen-shan Yuan, Xiao-yang Sun, Jiao Zhang, Hui Xie. A novel anterior odontoid screw plate for C1—C3 internal fixation. Spine. 2016;41(2):E64-E72. https://doi.org/10.1097/brs.0000000000001165
Xu Nanfang, Feng Wei, Xiaoguang Liu, Liang Jiang, Hong Cai, Zihe Li, Miao Yu, Fengliang Wu, Zhongjun Liu. Reconstruction of the upper cervical spine using a personalized 3D-printed vertebral body in an adolescent with Ewing sarcoma. Spine. 2016;41(1):E50-E54. https://doi.org/10.1097/brs.0000000000001179
Yin Qing-shui, Fu-zhi Ai, Kai Zhang, Xiao-hong Mai, Hong Xia, Zeng-hui Wu. Transoral atlantoaxial reduction plate internal fixation for the treatment of irreducible atlantoaxial dislocation: a 2- to 4-year follow-up. Orthopaedic Surgery. 2010;2(2):149-155. https://doi.org/10.1111/j.1757-7861.2010.00077.x
Zhang Bao Cheng, Hai Bo Liu, Xian Hua Cai, Zhi Hua Wang, Feng Xu, Xi Ming Liu, Hua Song Wang, Hui Kang, Ran Ding. Biomechanical comparison of modified TARP technique versus modified goel technique for the treatment of basilar invagination. Spine. 2016;41(8):E459-E466. https://doi.org/10.1097/brs.0000000000001297
Yin Qing-Shui, Xue-Shi Li, Zhao-Hui Bai, Xiao-Hong Mai, Hong Xia, Zeng-Hui Wu, Xiang-Yang Ma, Fu-Zhi Ai, Jian-Hua Wang, Kai Zhang. An 11-year review of the TARP procedure in the treatment of atlantoaxial dislocation. Spine. 2016;41(19):E1151-E1158. https://doi.org/10.1097/brs.0000000000001593
Zhang Bao-cheng, Hai-bo Liu, Xian-hua Cai, Zhi-hua Wang, Feng Xu, Hui Kang, Ran Ding, Xiao-qing Luo. Biomechanical comparison of a novel transoral atlantoaxial anchored cage with established fixation technique — a finite element analysis. BMC Musculoskeletal Disorders. 2015;16(1). https://doi.org/10.1186/s12891-015-0662-7
Kuleshov AA, Shkarubo AN, Gavryushenko NS, Gromov IS, Vetriele MS, Fomin LV, Marshakov VV. Comparative experimental study of an individual plate for anterior stabilization and dorsal fixation systems at the C1-C2 vertebrae level. Vestnik Travmatologii I ortopedii im. N.N. Priorov. 2016;1:76-81.