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La radiologia medica

, Volume 117, Issue 4, pp 616–635 | Cite as

Tumours of the atlas and axis: a 37-year experience with diagnosis and management

  • A. F. Mavrogenis
  • G. Guerra
  • M. Romantini
  • C. Romagnoli
  • R. Casadei
  • P. RuggieriEmail author
Musculoskeletal Radiology / Radiologia Muscolo-Scheletrica

Abstract

Purpose

This paper presents a single institution’s longterm experience regarding the incidence and management of tumours of the atlas and axis and discusses clinical and imaging findings and treatment options.

Materials and methods

We searched the registry of the Istituto Ortopedico Rizzoli for patients admitted and treated for tumours of the upper cervical spine. We identified 62 patients over 37 years, from July 1973 to October 2010. There were 39 male and 23 female patients, with a mean age of 39.5 (range 5–77) years. For each patient, we collected data on clinical presentation, imaging and treatment. Mean follow-up was 10 years.

Results

Benign bone tumours were diagnosed in 24 (39%) and malignant tumours in 38 (61%) patients. The most common tumours were bone metastases, followed by osteoid osteomas and chordomas. The atlas was involved in six and the axis in 52 patients; in four patients, both the atlas and axis were involved. The most common clinical presentation was pain, torticollis, dysphagia and neurological deficits. Surgical treatment was performed in 35 patients and conservative treatment, including intralesional methylprednisolone injections and halo-vest immobilisation with or without radiation therapy, chemotherapy or embolisation, in the remaining patients. One patient with osteoblastoma of the atlas had local recurrence. All patients with metastatic bone disease had local recurrence; four of the eight patients with plasmacytoma progressed to multiple myeloma within 1–4 years. All patients with chordomas had two to four local recurrences. Patients with osteosarcomas and chondrosarcoma died owing to local and distant disease progression.

Conclusions

Bone tumours of the cervical spine are rare. However, they should be kept in mind when examining patients with neck pain or neurological symptoms at the extremities. In most cases, only intralesional surgery can be administered. Combined radiation therapy and chemotherapy is indicated for certain tumour histologies.

Keywords

Atlas Axis Bone tumours 

Tumori dell’atlante e dell’epistrofeo: 37 anni di esperienza nella diagnosi e trattamento

Riassunto

Obiettivo

Vogliamo riportare l’esperienza raccolta presso un unico istituto in un lungo arco di tempo sull’incidenza e la gestione delle neoplasie dell’atlante e dell’epistrofeo, analizzandone riscontri clinici e radiologici, e le opzioni terapeutiche.

Materiali e metodi

Ricercando nell’archivio dell’Istituto Ortopedico Rizzoli tutta la documentazione relativa ai pazienti trattati per neoplasie del rachide cervicale superiore, sono stati individuati 62 pazienti in un arco di tempo di 37 anni (da luglio 1973 ad ottobre 2010), 39 uomini e 23 donne, con età media di 39,5 anni (5–77 anni). Di ogni paziente sono stati raccolti i dati circa le manifestazioni cliniche al momento del ricovero, la documentazione radiologica ed il trattamento eseguito. Il tempo di controllo medio è stato di 10 anni.

Risultati

In 24 casi (39%) è stata diagnosticata una neoplasia benigna, in 38 (61%) una neoplasia maligna. Metastasi ossee, osteomi osteoidi e cordomi sono stati rispettivamente gli istotipi più frequenti. In 6 pazienti la neoplasia interessava l’atlante e in 52 l’epistrofeo; in 4 pazienti la neoplasia interessava sia l’atlante che l’epistrofeo. Le manifestazioni cliniche più frequenti comprendevano dolore, torcicollo, disfagia e deficit neurologici. Il trattamento chirurgico è stato eseguito in 35 casi, mentre nei rimanenti casi è stato eseguito trattamento conservativo mediante infiltrazioni intralesionali di metilprednisolone ed immobilizzazione con halo vest, associato o meno a chemioterapia, radioterapia o embolizzazione. Un paziente con osteoblastoma dell’atlante ha avuto recidiva locale; tutti i pazienti con metastasi hanno sviluppato recidive locali. Degli 8 pazienti con diagnosi di plasmocitoma solitario, per 4 c’è stata la progressione a mieloma multiplo in un tempo compreso tra 1 e 4 anni. I pazienti con diagnosi di cordoma hanno sviluppato dalle 2 alle 4 recidive locali. I pazienti con diagnosi di osteosarcoma e condrosarcoma sono deceduti per la progressione locale e a distanza della malattia.

Conclusioni

I tumori ossei del rachide cervicale sono rari. Non possono tuttavia essere esclusi nei casi di cervicalgia e sintomatologia neurologica periferica. In molti casi il trattamento chirurgico può essere soltanto a margini intralesionali. Per determinati istotipi è indicata l’associazione con chemio e radioterapia.

Parole chiave

Atlante Epistrofeo Tumori ossei 

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References/Bibliografia

  1. 1.
    Unni KK (1996) Dahlin’s bone tumors. General aspects and data on 11,087 cases. Lippincott-Raven, PhiladelphiaGoogle Scholar
  2. 2.
    Harrington KD (1993) Metastatic tumors of the spine: diagnosis and treatment. J Am Acad Orthop Surg 1:76–86Google Scholar
  3. 3.
    Boriani S, Sundaresan N, Weinstein JN (1998) Primary malignant tumors of the cervical spine. In: Clark CR, Benzel EC (eds) The cervical spine. Lippincott-Raven, Philadelphia, pp 643–657Google Scholar
  4. 4.
    Abdu WA, Provencher M (1998) Primary bone and metastatic tumors of the cervical spine. Spine 23:2767–2777PubMedCrossRefGoogle Scholar
  5. 5.
    Papagelopoulos PJ, Mavrogenis AF, Currier BL et al (2004) Primary malignant tumors of the cervical spine. Orthopedics 27:1066–1077PubMedGoogle Scholar
  6. 6.
    Ilaslan H, Sundaram M, Unni KK (2003) Vertebral chondroblastoma. Skeletal Radiol 32:66–71PubMedCrossRefGoogle Scholar
  7. 7.
    Nishida J, Kato S, Murakami H et al (2003) Tetraparesis caused by chondroblastoma of the cervical spine: a case report. Spine (Phila Pa 1976) 28:E173–E178Google Scholar
  8. 8.
    Boriani S, Weinstein JN, Biagini R (1997) Primary bone tumors of the spine. Terminology and surgical staging. Spine 22:1036–1044Google Scholar
  9. 9.
    Papagelopoulos PJ, Currier BL, Galanis E et al (2002) Vertebra plana caused by primary Ewing sarcoma: case report and review of the literature. J Spinal Disord Tech 15:252–257PubMedCrossRefGoogle Scholar
  10. 10.
    McLain RF, Weinstein JN (1989) Solitary plasmacytomas of the spine: a review of 84 cases. J Spinal Disord 2:69–74PubMedCrossRefGoogle Scholar
  11. 11.
    Brugieres P, Gaston A, Voisin MC et al (1992) CT-guided percutaneous biopsy of the cervical spine: a series of 12 cases. Neuroradiology 34:358–360PubMedCrossRefGoogle Scholar
  12. 12.
    Hart RA, Boriani S, Biagini R et al (1997) A system for surgical staging and management of spine tumors. A clinical outcome study of giant cell tumors of the spine. Spine 22:1773–1783PubMedCrossRefGoogle Scholar
  13. 13.
    Springfield DS, Rosenberg A (1996) Biopsy: complicated and risky. J Bone Joint Surg Am 78:639–643PubMedGoogle Scholar
  14. 14.
    Rengachary SS, Sanan A (1998) Ivory osteoma of the cervical spine: case report. Neurosurgery 42:182–185PubMedCrossRefGoogle Scholar
  15. 15.
    Levine AM, Boriani S (1998) Benign tumors of the cervical spine. In: Clark CR, Benzel EC (eds) The cervical spine. Lippincott-Raven, Philadelphia, pp 621–641Google Scholar
  16. 16.
    Wang W, Kong L, Dong R et al (2006) Osteoma in the upper cervical spine with spinal cord compression. Eur Spine J 15(Suppl 5):616–620PubMedCrossRefGoogle Scholar
  17. 17.
    Zileli M, Çagli S, Basdemir G, Ersahin Y (2003) Osteoid osteomas and osteoblastomas of the spine. Neurosurg Focus 15:1–6Google Scholar
  18. 18.
    Pettine KA, Klassen RA (1986) Osteoid osteoma and osteoblastoma of the spine. J Bone Joint Surg Am 68:354–361PubMedGoogle Scholar
  19. 19.
    Ozaki T, Liljenqvist U, Hillmann A et al (2002) Osteoid osteoma and osteoblastoma of the spine. Experiences with 22 patients. Clin Orthop Relat Res 397:394–402PubMedCrossRefGoogle Scholar
  20. 20.
    Rybak LD, Gangi A, Buy X et al (2010) Thermal ablation of spinal osteoid osteomas close to neural elements: technical considerations. AJR Am J Roentgenol 195:W293–W298PubMedCrossRefGoogle Scholar
  21. 21.
    Menezes AH (2008) Craniovertebral junction neoplasms in the pediatric population. Childs Nerv Syst 24:1173–1186PubMedCrossRefGoogle Scholar
  22. 22.
    Nemoto O, Moser RP, Van Dam BE et al (1990) Osteoblastoma of the spine: review of 75 cases. Spine 15:1272–1280PubMedCrossRefGoogle Scholar
  23. 23.
    Healey JH, Ghelman B (1986) Osteoidosteoma and osteoblastoma: current concepts and recent advances. Clin Orthop Relat Res 204:76–85PubMedGoogle Scholar
  24. 24.
    Syklawer R, Osborn RE, Kerber CW et al (1990) MRI of vertebral osteoblastoma: report of two cases. Surg Neurol 34:421–426PubMedCrossRefGoogle Scholar
  25. 25.
    Lopez-Barea F, Rodriguez-Peralto JL, Hernandez-Moneo JL et al (1994) Tumors of the atlas. 3 incidental cases of osteochondroma, benign osteoblastoma, and atypical Ewing’s sarcoma. Clin Orthop Relat Res 307:182–188PubMedGoogle Scholar
  26. 26.
    Tarantino R, Piccirilli M, Anichini G, Delfini R (2008) Benign osteoblastoma of the odontoid process of the axis with secondary aneurysmal bone cyst component: a case report. Neurosurg Rev 31:111–115PubMedCrossRefGoogle Scholar
  27. 27.
    Arvin B, Panchmatia JR, Casey AT (2009) Cervical C2 osteoma, unusual presentation and transoral approach for complete excision. Spine J 9:e9–e11PubMedCrossRefGoogle Scholar
  28. 28.
    Amacher AL, Eltormey A (1985) Spinal osteoblastoma in children and adolescents. Childs Nerv Syst 1:29–32PubMedCrossRefGoogle Scholar
  29. 29.
    Moore T, McLain RF (2005) Imageguided surgery in resection of benign cervicothoracic spinal tumors: report of two cases. Spine J 5:109–114PubMedCrossRefGoogle Scholar
  30. 30.
    Shikata J, Yamamuro T, Hiokazu I et al (1987) Benign osteoblastoma of the cervical spine: a review of 75 cases. Surg Neurol 27:381–385PubMedCrossRefGoogle Scholar
  31. 31.
    Sweasey TA, Dauser RC (1989) Eosinophilic granuloma of the cervicothoracic junction. Case report. J Neurosurg 71:942–944Google Scholar
  32. 32.
    Tanaka N, Fujimoto Y, Okuda T et al (2005) Langerhans cell histiocytosis of the atlas. A report of three cases. J Bone Joint Surg Am 87:2313–2317PubMedCrossRefGoogle Scholar
  33. 33.
    Bertram C, Madert J, Eggers C (2002) Eosinophilic granuloma of the cervical spine. Spine 27:1408–1413PubMedCrossRefGoogle Scholar
  34. 34.
    Dickinson LD, Farhat SM (1991) Eosinophilic granuloma of the cervical spine. A case report and review of the literature. Surg Neurol 35:57–63PubMedCrossRefGoogle Scholar
  35. 35.
    Metellus P, Gana R, Fuentes S et al (2007) Spinal Langerhans’ cell histiocytosis in a young adult: case report and therapeutic considerations. Br J Neurosurg 21:228–230PubMedCrossRefGoogle Scholar
  36. 36.
    Yeom JS, Lee CK, Shin HY et al (1999) Langerhans’ cell histiocytosis of the spine. Analysis of twenty-three cases. Spine 24:1740–1749PubMedCrossRefGoogle Scholar
  37. 37.
    Osenbach RK, Youngblood LA, Menezes AH (1990) Atlanto-axial instability secondary to solitary eosinophilic granuloma of C2 in a 12-year-old girl. J Spinal Disord 3:408–412PubMedGoogle Scholar
  38. 38.
    Scarpinati M, Artico M, Artizzu S (1995) Spinal cord compression by eosinophilic granuloma of the cervical spine. Case report and review of the literature. Neurosurg Rev 18:209–212PubMedCrossRefGoogle Scholar
  39. 39.
    Levy EI, Scarrow A, Hamilton RC et al (1999) Medical management of eosinophilic granuloma of the cervical spine. Pediatr Neurosurg 31:159–162PubMedCrossRefGoogle Scholar
  40. 40.
    Rimondi E, Mavrogenis AF, Rossi G et al (2010) CT-guided corticosteroid injection for solitary eosinophilic granuloma of the spine. Skeletal Radiol 40:757–764PubMedCrossRefGoogle Scholar
  41. 41.
    Boriani S, De Iure F, Campanacci L et al (2001) Aneurysmal bone cyst of the mobile spine: report on 41 cases. Spine 26:27–35PubMedCrossRefGoogle Scholar
  42. 42.
    Ozaki T, Halm H, Hillmann A, Shaffrey CI (1999) Aneurysmal bone cysts of the spine. Arch Orthop Trauma Surg 119:159–162PubMedCrossRefGoogle Scholar
  43. 43.
    Papagelopoulos PJ, Currier BL, Shaughnessy WJ et al (1998) Aneurysmal bone cyst of the spine. Management and outcome. Spine 23:621–628Google Scholar
  44. 44.
    Bongioanni F, Assadurian E, Polivka M, George B (1996) Aneurysmal bone cyst of the atlas: operative removal through an anterolateral approach. A case report. J Bone Joint Surg Am 78:1574–1577Google Scholar
  45. 45.
    Gladden ML Jr, Gillingham BL, Hennrikus W, Vaughan LM (2000) Aneurysmal bone cyst of the first cervical vertebrae in a child treated with percutaneous intralesional injection of calcitonin and methylprednisolone. A case report. Spine 25:527–531Google Scholar
  46. 46.
    Mohit AA, Eskridge J, Ellenbogen R, Shaffrey CI (2004) Aneurysmal bone cyst of the atlas: successful treatment through selective arterial embolization: case report. Neurosurgery 55:982PubMedCrossRefGoogle Scholar
  47. 47.
    Rai AT, Collins JJ (2005) Percutaneous treatment of pediatric aneurysmal bone cyst at C1: a minimally invasive alternative: a case report. AJNR Am J Neuroradiol 26:30–33PubMedGoogle Scholar
  48. 48.
    Andersen BJ, Goldhagen P, Caliill DW (1991) Aneurysmal bone cyst of the odontoid process: case report. Neurosurgery 28:592–594PubMedCrossRefGoogle Scholar
  49. 49.
    Legre J, Paillas JE, Serratrice G, Combalbert A (1964) Deux nouvelles observations de kyste anévrysmal du rachis a localization inhabituelle (sacrum et atlas). Neurochirurgie 10:163–168PubMedGoogle Scholar
  50. 50.
    Pouyanne H, Leman P, Got M et al (1961) Kyste anévrysmal monstrueux de l’atlas et de l’axis. Etude angiographique. Neurochirurgie 7:132–135Google Scholar
  51. 51.
    Wang VY, Deviren V, Ames CP (2009) Reconstruction of C-1 lateral mass with titanium mesh cage after resection of an aneurysmal bone cyst of the atlas. J Neurosurg Spine 10:117–121PubMedCrossRefGoogle Scholar
  52. 52.
    George B, Archilli M, Cornelius JF (2006) Bone tumors at the craniocervical junction. Surgical management and results from a series of 41 cases. Acta Neurochir (Wien) 148:741–749CrossRefGoogle Scholar
  53. 53.
    George B, Dematons C, Cophignon J (1988) Lateral approach to the anterior portion of the foramen magnum. Application to surgical removal of 14 benign tumors: technical note. Surg. Neurol 29:484–490Google Scholar
  54. 54.
    Menezes AH, Traynelis VC (2008) Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b). Childs Nerv Syst 24:1091–1100PubMedCrossRefGoogle Scholar
  55. 55.
    Combelles G, Delcambre B, Madelain M et al (1983) Le kyste anévrysmal rachidien. Considerations thérapeutiques a propos de 6 observations. Neurochirurgie 29:1–11PubMedGoogle Scholar
  56. 56.
    Hay MC, Paterson D, Taylor TK (1978) Aneurysmal bone cysts of the spine. J Bone Joint Surg 60-B:406–411Google Scholar
  57. 57.
    Sanjay BK, Sim FH, Unni KK et al (1993) Giant-cell tumours of the spine. J Bone Joint Surg Br 75-B:148–154Google Scholar
  58. 58.
    Biagini R, De Cristofaro R, Ruggieri P, Boriani S (1990) Giant-cell tumor of the spine: a case report. J Bone Joint Surg 72:1102–1107PubMedGoogle Scholar
  59. 59.
    Martin C, McCarthy EF (2010) Giant cell tumor of the sacrum and spine: series of 23 cases and a review of the literature. Iowa Orthop J 30:69–75PubMedGoogle Scholar
  60. 60.
    Di Lorenzo ND, Spallone A, Nolletti A, Nardi P (1980) Giant cell tumors of the spine: a clinical study of six cases, with emphasis on the radiological features, treatment and follow-up. Neurosurgery 6:29–34PubMedCrossRefGoogle Scholar
  61. 61.
    Fidler MW (2001) Surgical treatment of giant cell tumours of the thoracic and lumbar spine: report of nine patients. Eur Spine J 10:69–77PubMedCrossRefGoogle Scholar
  62. 62.
    Rock MG, Pritchard DJ, Unni KK (1984) Metastases from histologically benign giant cell tumor of bone. J Bone Joint Surg Am 66-A:269–274Google Scholar
  63. 63.
    Bertoni F, Present D, Sudanese A et al (1988) Giant-cell tumor of bone with pulmonary metastases. Six case reports and a review of the literature. Clin Orthop Relat Res 237:275–285Google Scholar
  64. 64.
    Kay RM, Eckardt JJ, Seeger LL et al (1994) Pulmonary metastasis of benign giant cell tumor of bone. Six histologically confirmed cases, including one of spontaneous regression. Clin Orthop Relat Res 302:219–230PubMedGoogle Scholar
  65. 65.
    McGough RL, Rutledge J, Lewis VO et al (2005) Impact severity of local recurrence in giant cell tumor of bone. Clin Orthop Relat Res 438:116–122PubMedCrossRefGoogle Scholar
  66. 66.
    Sanerkin NG (1980) Malignancy, aggressiveness, and recurrence in giant cell tumor of bone. Cancer 46:1641–1649PubMedCrossRefGoogle Scholar
  67. 67.
    Dorfman HD, Czerniak B (1998) Bone Tumours. Mosby Inc., St. LouisGoogle Scholar
  68. 68.
    Marcove RC, Lindeque BG, Huvos AG (1989) Fibromyxoma of the bone. Surg Gynecol Obstet 169:115–118PubMedGoogle Scholar
  69. 69.
    Hardes J, Scheil-Bertram S, Gosheger G, Schulte M (2006) Fibromyxoma of bone: a case report and review of the literature. Acta Orthop Belg 72:100–104PubMedGoogle Scholar
  70. 70.
    Adler CP (1981) Fibromyxoma of the femoral neck. J Cancer Res ClinOncol 101:183–189CrossRefGoogle Scholar
  71. 71.
    Sundaram M, Janney C, McDonald DJ (2000) Myxoma of the humerus: an exceptional site of origin. Skeletal Radiol 29:57–60PubMedCrossRefGoogle Scholar
  72. 72.
    Abdelwahab FI, Hermann G, Klein MJ et al (1991) Fibromyxoma of bone. Skeletal Radiol 20:95–98PubMedGoogle Scholar
  73. 73.
    Tomita K, Kawahara N, Baba H et al (1997) Total en block spondylectomy. A new surgical technique for primary malignant vertebral tumors. Spine 22:324–333PubMedCrossRefGoogle Scholar
  74. 74.
    Tomita K, Kawahara N, Mizuno K et al (1994) Total en bloc spondylectomy for primary malignant vertebral tumors. In: Rao RS, Deo MG, Sanghri LD, Mittra I (eds) Proceedings of the 16th International Cancer Congress. Monduzzi Editore, Bologna, pp 2409–2413Google Scholar
  75. 75.
    Fujita T, Kawahara N, Matsumoto T, Tomita K (1999) Chordoma in the cervical spine managed with en bloc excision. Spine 24:1848–1851PubMedCrossRefGoogle Scholar
  76. 76.
    Shives TC, McLeod RA, Unni KK, Schray MF (1989) Chondrosarcoma of the spine. J Bone Joint Surg Am 71:1158–1165PubMedGoogle Scholar
  77. 77.
    Shives TC, Dahlin DC, Sim FH et al (1986) Osteosarcoma of the spine. J Bone Joint Surg Am 68:660–668PubMedGoogle Scholar
  78. 78.
    Tomita K, Toribatake Y, Kawahara N et al (1994) Total en bloc spondylectomy and circumspinal decompression for solitary spinal metastasis. Paraplegia 32:36–46PubMedCrossRefGoogle Scholar
  79. 79.
    Tomita K, Kawahara N, Takahashi K et al (1994) Total en bloc spondylectomy for malignant vertebral tumors. Orthopaedic Transactions 18:1166Google Scholar
  80. 80.
    Cohen ZR, Fourney DR, Marco RA et al (2002) Total cervical spondylectomy for primary osteogenic sarcoma. Case report and description of operative technique. J Neurosurg Spine 97:386–392CrossRefGoogle Scholar
  81. 81.
    Hoshino Y, Kurokawa T, Nakamura K et al (1996) A report on the safety of unilateral vertebral artery ligation during cervical spine surgery. Spine 21:1454–1457PubMedCrossRefGoogle Scholar
  82. 82.
    Drake CG (1975) Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms. J Neurosurg 43:255–274PubMedCrossRefGoogle Scholar
  83. 83.
    Takakuwa T, Hiroi S, Hasegawa H et al (1994) Os odontoideum with vertebral artery occlusion. Spine 19:460–462PubMedCrossRefGoogle Scholar
  84. 84.
    Akamaru T, Kawahara N, Tsuchiya H et al (2002) Healing of autologous bone in a titanium mesh cage used in anterior column reconstruction after total spondylectomy. Spine 27:E329–E333PubMedCrossRefGoogle Scholar
  85. 85.
    Sundaresan N, Krol G, Hughes JE (1990) Primary malignant tumors of the spine. In: Youmans JR (ed) Neurological Surgery. WB Saunders Co, Philadelphia, pp 3548–3573Google Scholar
  86. 86.
    Huvos AG (1991) Bone tumors: diagnosis, treatment, and prognosis. WB Saunders, Philadelphia, pp 599–624Google Scholar
  87. 87.
    Dahlin DC, MacCarthy CS (1952) Chordoma: a study of fifty-nine cases. Cancer 5:1170–1178PubMedCrossRefGoogle Scholar
  88. 88.
    Borba LA, Al Mefty O, Mrak RE, Suen J (1996) Cranial chordomas in children and adolescents. J Neurosurg 84:584–591PubMedCrossRefGoogle Scholar
  89. 89.
    Coffin CM, Swanson PE, Wick MR, Dehner LP (1993) Chordoma in childhood and adolescence. A clinicopathologic analysis of 12 cases. Arch Pathol Lab Med 117:927–933PubMedGoogle Scholar
  90. 90.
    Menezes AH, Gantz BJ, Traynelis VC, McCulloch TM (1997) Cranial base chordomas. Clin Neurosurg 44:491–509PubMedGoogle Scholar
  91. 91.
    Boriani S, Chevalley F, Weinstein JN et al (1996) Chordoma of the spine above the sacrum. Treatment and outcome in 21 cases. Spine 21:1569–1577PubMedCrossRefGoogle Scholar
  92. 92.
    Forsyth PA, Cascino TL, Shaw EG et al (1993) Intracranial chordomas: a clinicopathological and prognostic study of 51 cases. J Neurosurg 78:741–747PubMedCrossRefGoogle Scholar
  93. 93.
    Gay E, Sekhar LN, Rubinstein E et al (1995) Chordomas and chondrosarcomas of the cranial base: results and follow-up of 60 patients. Neurosurgery 36:887–896PubMedCrossRefGoogle Scholar
  94. 94.
    Watkins L, Khudados ES, Kaleoglu M et al (1993) Skull base chordomas: a review of 38 patients, 1958–88. Br J Neurosurg 7:241–248PubMedCrossRefGoogle Scholar
  95. 95.
    Austin JP, Urie MM, Cardenosa G, Munzenrider JE (1993) Probable causes of recurrence in patients with chordoma and chondrosarcoma of the base of skull and cervical spine. Int J RadiatOncol Biol Phys 25:439–444CrossRefGoogle Scholar
  96. 96.
    Benk V, Liebsch NJ, Munzenrider JE et al (1995) Base of skull and cervical spine chordomas in children treated by high-dose irradiation. Int J Radiat Oncol Biol Phys 31:577–581PubMedCrossRefGoogle Scholar
  97. 97.
    Fagundes MA, Hug EB, Liebsch NJ et al (1995) Radiation therapy for chordomas of the base of skull and cervical spine: patterns of failure and outcome after relapse. Int J Radiat Oncol Biol Phys 33:579–584PubMedCrossRefGoogle Scholar
  98. 98.
    Marucci L, Niemierko A, Liebsch NJ et al (2004) Spinal cord tolerance to high-dose fractionated 3D conformal proton-photon irradiation as evaluated by equivalent uniform dose and dose volume histogram analysis. Int J Radiat Oncol Biol Phys 59:551–555PubMedCrossRefGoogle Scholar
  99. 99.
    Noël G, Feuvret L, Calugaru V et al (2005) Chordomas of the base of the skull and upper cervical spine. One hundred patients irradiated by a 3D conformal technique combining photon and proton beams. Acta Oncol 44:700–708PubMedCrossRefGoogle Scholar
  100. 100.
    Debus J, Schulz-Ertner D, Schad L et al (2000) Stereotactic fractionated radiotherapy for chordomas and chondrosarcomas of the skull base. Int J Radiat Oncol Biol Phys 47:591–596PubMedCrossRefGoogle Scholar
  101. 101.
    Hao DP, Xu WJ, Wang ZC et al (2010) Primary Ewing’s sarcoma of the cervical vertebra: one case report and literature review. J Pediatr Orthop B 19:276–280PubMedCrossRefGoogle Scholar
  102. 102.
    Grubb MR, Currier BL, Pritchard DJ, Ebersold MJ (1994) Primary Ewing’s sarcoma of the spine. Spine 19:309–313PubMedCrossRefGoogle Scholar
  103. 103.
    Hart RA, Weinstein JN (1995) Primary benign and malignant musculoskeletal tumors of the spine. Semin Spine Surg 7:288–302Google Scholar
  104. 104.
    Roessner A, Boehling T (2002) Angiosarcoma. In: Fletcher CDM, Unni KK, Mertens F (eds) World Health Organization classification of tumours of soft tissue and bone. Pathology and genetics of tumours of soft tissue and bone. IARC Press, Lyon, pp 322–323Google Scholar
  105. 105.
    Aflatoon K, Staals E, Bertoni F et al (2004) Hemangioendothelioma of the spine. Clin Orthop Relat Res 418:191–197PubMedCrossRefGoogle Scholar
  106. 106.
    Campanacci M, Boriani S, Giunti A (1980) Hemangioendothelioma of bone: a study of 29 cases. Cancer 46:804–814PubMedCrossRefGoogle Scholar
  107. 107.
    Marks DS, Thomas AM, Thompson AG et al (1995) Surgical management of haemangioendothelioma of the spine. Eur Spine J 4:186–190PubMedCrossRefGoogle Scholar
  108. 108.
    Harrington KD (1986) Metastatic disease of the spine. J Bone Joint Surg Am 68:1110–1115PubMedGoogle Scholar
  109. 109.
    Hussein AA, El-Karef E, Hafez M (2001) Reconstructive surgery in spinal tumours. Eur J Surg Oncol 27:196–199PubMedGoogle Scholar
  110. 110.
    Rayan F, Mukundan C, Shukla DD, Barrington RL (2009) Odontoid metastasis: a potential lethal complication. J Orthop Traumatol 10:199–201PubMedCrossRefGoogle Scholar
  111. 111.
    Anselmetti GC, Manca A, Chiara G, Regge D (2009) Painful osteolytic metastasis involving the anterior and posterior arches of C1: percutaneous vertebroplasty with local anesthesia. J Vasc Interv Radiol 20:1645–1647PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • A. F. Mavrogenis
    • 1
  • G. Guerra
    • 1
  • M. Romantini
    • 1
  • C. Romagnoli
    • 1
  • R. Casadei
    • 1
  • P. Ruggieri
    • 1
    Email author
  1. 1.Orthopaedic Oncology Service, Department of Orthopaedics, Istituto Ortopedico RizzoliUniversity of BolognaBolognaItaly

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