gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Article

Send article

Treatment of cervico-spinal giant cell tumors – case report and systematic review

Meeting Abstract

Search Medline for

  • Michael Müther - Dept. of Neurosurgery, Münster, Deutschland
  • Michael Schwake - Münster, Deutschland
  • Hendrik Berssenbrügge - Münster, Deutschland
  • Walter Stummer - Münster, Deutschland
  • Ewelt Christian - Münster, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.21.01

doi: 10.3205/17dgnc504, urn:nbn:de:0183-17dgnc5041

Published: June 9, 2017

© 2017 Müther et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Giant Cell Tumors (GCT) account for 5% of bone tumors, spinal GCT again form 5% of all GCT. Generally considered benign, local aggressiveness and metastatic growth have been described. Because of low prevalence mostly small clinical series have been published on GCT in the cervical spine. In this work we present a case of a GCT in the second cervical vertebra and put our treatment in context of current literature.

Methods: We report the surgical treatment of a GCT in the second cervical vertebra. Literature search on pubmed.gov was performed using the following headings: giant cell tumor AND cervical spine, osteoclastoma AND cervical spine. 161 abstracts were analyzed according to the PRISMA-protocol.

Results: A 35-year-old male presented with a six week history of headache and neck pain. CT and MRI showed an osteolytic lesion of the second cervical vertebra and signs of atlanto-axial instability. In a first step fusion of the first four cervical vertebrae was performed. After a needle biopsy through one of the screw canals an aneurysmal bone cyst was found to be the most likely diagnosis. Accordingly transoral resection of the dentoid process, local tumor curettage and interposition of an autologous bone graft was performed. At this point GCT was diagnosed. Whole body FDG-PET staging showed no signs of metastases. During follow-up the patient remained asymptomatic, the cervical fusion remained stable.

Conclusion: In terms of best oncologic treatment an aggressive surgical strategy should be considered in GCT. However, radical excision of an affected cervical vertebra is mostly not feasible due to anatomical and functional complexity. In cases of spinal instability an initial posterior fusion and biopsy appears to be a reasonable first step. As pathology may be wrong initially as in this case, local surgical control via an anterior approach should be a major treatment goal. If negative surgical margins cannot be achieved adjuvant treatment such as radiotherapy, Zolendronic Acid or Denosumab must be considered.