Mandibular-Tongue Splitting Approach for Treatment of Upper Cervical Spine chordoma. A Case Report.

The transoral approach is the most popular method for exposure of the upper cervical spine. However, since only a small area of exposure can be achieved with this approach, we have used the mandibular-tongue splitting approach, for removal of an upper cervical spine chordoma. Splitting of the soft palate, tongue and lower mandible were performed following tracheotomy and intubation. The entire surface of the tumor was then exposed by incision of the pharangeal mucosa. The tumor was resected and then anterior spinal fusion from the atlas to the fourth cervdcal vertebra was performed. Symptoms such as severe cervical pain, upper limb weakness and urinary dysfunction rapidly improved following surgery. Posterior stabilization from occiput to seventh cervical vertebra using Hartshill-Ransford loop was added two and a half months after the initial surgery.