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Treatment of osteoblastoma at C3-4 in a child: a case report.

Feng G, Huang K, Li L, Gong Q, Liu H, Song Y - BMC Musculoskelet Disord (2014)

Bottom Line: The pathophysiology of symptom development, evaluations, and management are presented.Hemostatic gelatin sponges were used to compress the bleeding site instantly and a tricortical iliac crest fixed with a screw was also used to add pressure to the gelatin sponges.This case delineates the difficulties in diagnosing this tumor, the challenges and problems encountered during its surgical management, and the favorable prognosis after adequate treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, West China Hospital, Sichuan University, 17 Renmin South Road, Chengdu, Sichuan (610041), P,R, China. liuhao6304@163.com.

ABSTRACT

Background: Osteoblastoma is a rare and benign osteoid-producing primary bone tumor that affects mainly the long bones. 36% of these tumors are observed around the spine and the vast majority arises around the posterior.

Case presentation: This report describes a case of C3-4 osteoblastoma occurring in a 5-year-and-8-month-old Han Chinese child. The pathophysiology of symptom development, evaluations, and management are presented. Because of the close proximity of the osteoblastoma to the vertebral artery canal, the artery suffered a minor laceration intraoperatively. Hemostatic gelatin sponges were used to compress the bleeding site instantly and a tricortical iliac crest fixed with a screw was also used to add pressure to the gelatin sponges. Fusion on the other side was also used to stabilize the spine. To the best of our knowledge, this is the first report of a case of osteoblastoma at C3-4 with artery injury intraoperatively.

Conclusions: This case delineates the difficulties in diagnosing this tumor, the challenges and problems encountered during its surgical management, and the favorable prognosis after adequate treatment.

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Related in: MedlinePlus

Intraoperative radiograph shows no spinal instability after anesthesia was induced and the Mayfield clamp was positioned (A), and the result of the reconstructive technique (B).
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Fig4: Intraoperative radiograph shows no spinal instability after anesthesia was induced and the Mayfield clamp was positioned (A), and the result of the reconstructive technique (B).

Mentions: After anesthesia, the patient was placed carefully in the prone position with a Mayfield 3-point head holder. Fluoroscopy confirmed that no iatrogenic subluxation or dislocation was caused by this position (Figure 4A). During the operation, a posterior approach was chosen and the lamina and articular complex of C2-C5 was exposed. A hemilaminectomy from C3 to C4 and facetectomy of the right side were performed. After laminectomy and facetectomy, the tumor was isolated. With a curette, the tumor was removed grossly and the spinal cord was decompressed. The circumferential margin of normal bony tissue was also removed with a high-speed burr. However, the right vertebral artery was injured during the extensive intralesional resection because of the close proximity of the tumor to the vertebral artery canal. The minor laceration of the vertebral artery was caused by the high-speed drill. During the drilling process, we observed a surge of bright red blood with rapid pulsatile flow. The area was quickly packed with the hemostatic, thrombin-soaked gelatin sponges and cottonoids. When complete hemostasis was obtained, a tricortical iliac crest was used to fill the bony gap left after the tumor mass excision and was fixed with a screw. The crest also added pressure to the gelatin sponges to prevent postoperative bleeding. Subsequently, the screw was connected with the upper and lower lateral mass screw-rod system (Figure 4B). The right-side facets were decorticated and fused to stabilize the spine.The pathologic examination of the surgical specimen indicated osteoblastoma (Figure 5A, B). The pain of the neck was relieved significantly postoperatively. The patient gradually recovered neurologic function. At the 12-month follow up, the patient presented full neurologic recovery and no evidence of recurrence by CT scan (Figure 6).Figure 4


Treatment of osteoblastoma at C3-4 in a child: a case report.

Feng G, Huang K, Li L, Gong Q, Liu H, Song Y - BMC Musculoskelet Disord (2014)

Intraoperative radiograph shows no spinal instability after anesthesia was induced and the Mayfield clamp was positioned (A), and the result of the reconstructive technique (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4195949&req=5

Fig4: Intraoperative radiograph shows no spinal instability after anesthesia was induced and the Mayfield clamp was positioned (A), and the result of the reconstructive technique (B).
Mentions: After anesthesia, the patient was placed carefully in the prone position with a Mayfield 3-point head holder. Fluoroscopy confirmed that no iatrogenic subluxation or dislocation was caused by this position (Figure 4A). During the operation, a posterior approach was chosen and the lamina and articular complex of C2-C5 was exposed. A hemilaminectomy from C3 to C4 and facetectomy of the right side were performed. After laminectomy and facetectomy, the tumor was isolated. With a curette, the tumor was removed grossly and the spinal cord was decompressed. The circumferential margin of normal bony tissue was also removed with a high-speed burr. However, the right vertebral artery was injured during the extensive intralesional resection because of the close proximity of the tumor to the vertebral artery canal. The minor laceration of the vertebral artery was caused by the high-speed drill. During the drilling process, we observed a surge of bright red blood with rapid pulsatile flow. The area was quickly packed with the hemostatic, thrombin-soaked gelatin sponges and cottonoids. When complete hemostasis was obtained, a tricortical iliac crest was used to fill the bony gap left after the tumor mass excision and was fixed with a screw. The crest also added pressure to the gelatin sponges to prevent postoperative bleeding. Subsequently, the screw was connected with the upper and lower lateral mass screw-rod system (Figure 4B). The right-side facets were decorticated and fused to stabilize the spine.The pathologic examination of the surgical specimen indicated osteoblastoma (Figure 5A, B). The pain of the neck was relieved significantly postoperatively. The patient gradually recovered neurologic function. At the 12-month follow up, the patient presented full neurologic recovery and no evidence of recurrence by CT scan (Figure 6).Figure 4

Bottom Line: The pathophysiology of symptom development, evaluations, and management are presented.Hemostatic gelatin sponges were used to compress the bleeding site instantly and a tricortical iliac crest fixed with a screw was also used to add pressure to the gelatin sponges.This case delineates the difficulties in diagnosing this tumor, the challenges and problems encountered during its surgical management, and the favorable prognosis after adequate treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, West China Hospital, Sichuan University, 17 Renmin South Road, Chengdu, Sichuan (610041), P,R, China. liuhao6304@163.com.

ABSTRACT

Background: Osteoblastoma is a rare and benign osteoid-producing primary bone tumor that affects mainly the long bones. 36% of these tumors are observed around the spine and the vast majority arises around the posterior.

Case presentation: This report describes a case of C3-4 osteoblastoma occurring in a 5-year-and-8-month-old Han Chinese child. The pathophysiology of symptom development, evaluations, and management are presented. Because of the close proximity of the osteoblastoma to the vertebral artery canal, the artery suffered a minor laceration intraoperatively. Hemostatic gelatin sponges were used to compress the bleeding site instantly and a tricortical iliac crest fixed with a screw was also used to add pressure to the gelatin sponges. Fusion on the other side was also used to stabilize the spine. To the best of our knowledge, this is the first report of a case of osteoblastoma at C3-4 with artery injury intraoperatively.

Conclusions: This case delineates the difficulties in diagnosing this tumor, the challenges and problems encountered during its surgical management, and the favorable prognosis after adequate treatment.

Show MeSH
Related in: MedlinePlus