A rare case of giant cell tumor of body of axis: Surgical management with staged posterior occipitocervical fusion, anterior excision and reconstruction through anterior mandibulotomy

Abstract

Giant cell tumor (GCT) constitutes around 5% of all the skeletal tumors which usually occur between second and fourth decade. Cervical spine GCT is very rare, and only a few case reports have been reported. In view of complex anatomy, variable aggressiveness, and scanty literature, there is a lack of clear consensus in the evaluation and management of high cervical GCT. We present a 30-year-old male patient, a case of GCT involving C2 vertebral body with severe neck pain, C1–C2 instability, and neurological deficit (visual analog scale [VAS] - 10/10, Nurick Grade-IV, NDI - 97.7%) managed by staged procedures. Posterior occipitocervical stabilization followed by anterior corpectomy, intralesional excision of the mass through anterior mandibulotomy, and reconstruction with iliac crest bone graft was performed. Postoperatively, the patient received adjuvant Denosumab therapy for 6 months. Complete neurological improvement was seen by 3 months. The VAS and NDI scores were 1/10 and 11.1%, respectively, at 1-year follow-up. No radiological recurrence was seen on radiograph and magnetic resonance imaging at 2-year follow-up. C2 GCT managed by intralesional excision and global stabilization combined with Denosumab therapy provides good clinical improvement without recurrence on medium-term follow-up. We believe that extended transoral transmandibular approach provides an excellent wide field for excision of high cervical aggressive tumors.

Keywords

• anterior mandibulotomy
• axis vertebra
• denosumab
• extended transoral transpharyngeal approach
• giant cell tumor