Cervical Chondrosarcoma: Case Commentary

Doctors Park and An present a difficult case of a malignant chondrosarcoma (Cervical Chondrosarcoma) involving the right lateral portion of C2 and C3. The surgery included placement of instrumentation and iliac bone graft on the left from C1 to C4. An en bloc tumor resection was performed by first resecting the C2 root and vertebral artery posteriorly and then dissecting and removing the tumor from an anterior approach and placing an allograft. The patient is doing well 10-months out from surgery.

I suspect the authors performed endovascular testing to help make certain that vertebral artery sacrifice would not be associated with an infarct. Often, this can be done a few days before surgery and the vessel taken with coils at the same time. This allows the cerebrovascular system to adjust for a period of time before being tested with all of the physiologic changes associated with a prolonged procedure and anesthesia. If any deficits develop, the patient can be given some time to recover before proceeding with the tumor resection.

This was a relatively aggressive approach for a man with a limited life expectancy. While an en bloc resection is preferable, such a management strategy needs to be carefully considered. Some tumor cases can be managed more safely with internal decompression and subsequent removal of the peripheral portion. This is more attractive in those patients in which there is concern for a limited life expectancy.