Unilateral Transcondylar Approach to Chordoma of Bilateral C1 and Bilateral Occipital Condyles

Background: The far lateral transcondylar approach usually includes a lateral suboccipital craniectomy, a C1 hemilaminectomy, partial resection of the occipital condyle, and partial resection of the jugular tubercle. It is great for resection of a variety of vascular and neoplastic lesions located ventral and ventrolateral to the brainstem and upper cervical spine. It is typically used for masses involving the ipsilateral side of clivus, foramen magnum and upper cervical spine. In this case, we successfully treated a chordoma involving bilateral C1 and bilateral occipital condyles.

Case Description: An 18-year-old female with a history of cranio-cervical junction chordoma initially presented with neck pain and tongue heaviness. She underwent surgical debulking via endoscopic endonasal approach in 2016 followed by proton beam radiotherapy. She was doing well until two years later when she acutely developed a left sided headache and neck pain while walking that was preceded by 2 days of tongue heaviness, dysarthria and cough. A magnetic resonance image (MRI) showed a 3.8 × 5.8 × 2.9 cm craniocervical junction mass that involves right greater than left occipital condyles, clivus, and the right aspect of C1 with evidence of partial bony destruction on the CT suggestive of recurrent chordoma and she was referred to our hospital. The tumor was debulked using a right far-lateral transcondylar approach, she subsequently underwent cranio-cervical stabilization via lateral mass screws. After an uneventful recovery period of 3 days, the patient was discharged home at her neurological baseline.

Conclusion: The far lateral transcondylar approach provides optimal exposure to ventrolateral aspect of the brainstem and upper cervical spine. We discuss the technical details, operative techniques, morbidity and potential complications of using a unilateral transcondylar approach to safely resect a mass that involves bilateral C1 and bilateral occipital condyles. Additionally, we discuss the need for cranio-cervical stabilization following this approach.

Fig. 1 (A and B) Preoperative axial T1 with contrast demonstrates a mass involving the clivus, bilateral occipital condyles and C1 in an 18-year-old woman who presented with neck pain and dysarthria. The lesion was resected using a unilateral far lateral approach. (C and D) Postoperative axial T1 with contrast.

Publication History

Article published online:
05 February 2024