Trans-oral approach for the management of a C2 neuroblastoma.

Abstract

Neuroblastoma is the most common extra-cranial solid tumour in children. Metastasis in children to the upper cervical spine are quite rare. An 8-year-old boy was referred to our service following a relapse of a right adrenal stage 4 neuroblastoma with a metastatic deposit in C2. This anterior tumour mass was pressing on the spinal cord with increasing pain in the base of skull, but without gross neurological deficit. He underwent urgent MRI and CT scans and then emergent surgery. The first stage was a posterior stabilization from occiput to C5 with a posterior decompression from C1 to C3 followed by a trans-oral approach to resect the main anterior tumour mass and reconstruction. This is the first report of the use of a trans-oral approach to address a neuroblastoma lesion in the axial spine. This approach was used effectively to achieve local tumour clearance confirmed at 1-year follow-up. Pertinent information to the spinal surgeon on neuroblastoma and the use of the trans-oral approach to the axial spine are discussed.