Management of Plasmocytomas of the Craniocervical Junction with Early Stabilization

Objective: Plasmocytomas (PC) of the craniocervical junction (CCJ) are rare. Due to their destructive growth they may induce spinal instability and harbor the risk of sudden death. Although, the primary treatment of plasmocytomas is radiotherapy their location at the CCJ requires special consideration. We proposed to review the management of personal cases and to perform a review of the literature. Material and Methods: Retrospective clinical study, tertiary care center (2004-2012). Patients with a lesion of the CCJ (C0-C2) were identified. Clinical charts, imaging data, operative reports, and follow-up data were analyzed. A thorough literature review was performed. Results: The series comprised four patients (1 female, 3males), mean age 58 years. There were one lesion of C1 and three of C2, respectively. Two patients with neck pain received vertebroplasty (C1 and C2, respectively) and radiotherapy as primary management. However, in both secondary instability of the CCJ occurred after 12 and 5 months, respectively. They needed OCS. Patient number 3 was emergently operated because of sudden apnoe due to brainstem compression by a pathological C2 fracture. The outcome was good after vertebroplasty and OCS. Patient number 4 had neck pain. An early vertebroplasty and OCS resulted in a favorable outcome. Conclusion: PC are highly radiosensitive. However, at the CCJ a life-threatening instability may occur. Therefore, we favor early OCS and vertebroplasty in this location.