Paravertebral high cervical chordoma. A case report.

Area of Science:

• Neurosurgery
• Oncology
• Radiology

Background:

• Spinal chordomas typically present as midline tumors causing vertebral destruction.
• Lateral paravertebral chordomas are exceptionally rare, posing diagnostic challenges.

Observation:

• A large, right lateral cervical (C2-C3) chordoma extended into the spinal canal via an enlarged C2-C3 intervertebral foramen.
• Initial percutaneous biopsy suggested mucous adenocarcinoma, but neuroradiology indicated a slow-growing lesion like a schwannoma or neurofibroma.
• Surgical findings revealed a well-demarcated, capsulated tumor involving the nerve root, with histology confirming a low-grade chordoma (Ki-67/MIB-1<1%).

Findings:

• The study highlights a rare presentation of a lateral spinal chordoma.
• Neuroradiological features mimicked other nerve sheath tumors, underscoring the importance of considering chordoma in the differential diagnosis.
• Successful management involved partial tumor resection followed by proton beam therapy.

Implications:

• This case expands the understanding of chordoma's diverse clinical and radiological presentations.
• Accurate preoperative diagnosis is crucial for appropriate surgical planning and treatment of spinal tumors.
• Proton beam therapy may be a viable option for managing low-grade chordomas.