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Short Segment Stabilization by Protecting the Alar Ligaments in a Case of Eosinophilic Granuloma Involving the C2
Mustafa Kemal Ilik1, Abdülfettah Tumturk2, Halil Ulutabanca2
1Department of Neurosurgery, Farabi Hospital, Konya, Turkey.
Insights
Surgical management of C2 eosinophilic granuloma requires careful preservation of the alar ligaments. Avoiding occipital fusion ensures craniocervical junction stability post-resection.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Oncology
Background:
- The craniocervical junction, comprising the occipital bone, atlas, and axis, relies on intricate ligamentous structures for stability.
- Ligaments play a crucial role in maintaining the integrity of this complex anatomical region.
Observation:
- A 6-year-old boy presented with neck pain and was diagnosed with a C2 vertebral body and pedicle lesion.
- Imaging revealed a lytic bone lesion, and the patient underwent surgical resection via an anterior retropharyngeal approach.
- The surgical technique prioritized protecting the odontoid tip and alar ligaments, followed by C1-C3 posterior fixation and fusion with costal autografts.
Findings:
- Histologic examination confirmed the lesion as eosinophilic granuloma.
- Postoperative imaging at one year demonstrated successful fusion without instability, as the occiput was not involved in the fusion.
- The alar ligaments and odontoid tip were successfully preserved during the procedure.
Implications:
- Preserving the alar ligaments during surgical resection of C2 lesions is critical for maintaining craniocervical stability.
- Occipital involvement in fusion should be avoided when alar ligaments are intact to prevent instability.
- This case highlights a successful surgical strategy for managing eosinophilic granuloma at the C2 level in a pediatric patient.
Background:
The craniocervical junction is a complex anatomic location that contains the occipital bone, atlas, axis, and important complex ligamentous structures. The stability of this region is ensured only with the help of ligaments.
Case Description:
A 6-year-old boy was admitted to our clinic for neck pain. Computed tomography and magnetic resonance imaging revealed a lytic bone lesion involving the C2 vertebral body and pedicle without odontoid tip. The tumor was resected using an anterior retropharyngeal approach and a wide marginal resection method. The odontoid tip and alar ligaments were protected, and the costal autografts were located between the C1-odontoid tip and the C3 body. The costal graft was stabilized in the C3 body with a miniplate. Then, C1-C3 posterior fixation with fusion was performed. The craniocervical junction was not considered unstable because the occipital bone was not involved in the fusion. Histologic examination confirmed the diagnosis of eosinophilic granuloma. Fusion was detected on a 1-year postoperative cervical computed tomography scan.
Conclusions:
The occiput should not be involved in the fusion area when the alar ligaments are preserved during surgery for a C2 lesion.
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