J Neurol Surg B Skull Base 2016; 77 - LFP-14-06
DOI: 10.1055/s-0036-1592628

Giant Cell Tumor of the Second Cervical Vertebra: Case Report and Review of Literature

Michael Müther 1, Michael Schwake 1, Eric Suero 1, Hendrik Berssenbrügge 2, Walter Stummer 1, Christian Ewelt 1
  • 1Department of Neurosurgery, University Medical Center Münster, Münster, Germany
  • 2Department of Otorhinolaryngology, University Medical Center Münster, Münster, Germany

Objective: Giant Cell Tumors (GCT) account for 5% of bone tumors, and spinal GCT again form 5% of all GCT. Generally considered benign, local aggressiveness and metastatic growth has been described. Because of low prevalence mostly small clinical series have been published on GCT in the cervical spine. In this work we present a case of a GCT in the second cervical vertebra and put our treatment in context of current literature.

Methods: We report the surgical treatment of a GCT in the second cervical vertebra. Literature search on pubmed.gov was performed using the following headings: giant cell tumor AND cervical spine, osteoclastoma AND cervical spine.

Results: A 35-year-old male presented with a six week history of headache and neck pain. CT and MRI showed an osteolytic lesion of the second cervical vertebra and signs of atlanto-axial instability. In a first step fusion of the first four cervical vertebrae was achieved. A needle biopsy through one of the screw canals was done, showing an aneurysmal bone cyst. Accordingly transoral resection of the dentoid process, local tumor curettage and interposition of an autologous bone graft was performed. At this point GCT was diagnosed. Whole body FDG-PET staging showed no signs of metastases. During follow-up the patient remained asymptomatic, the cervical fusion remained stable.

Conclusion: In terms of best oncologic treatment curettage is not superior to en-bloc resection. However, radical excision of an affected cervical vertebra is mostly not feasible due to anatomical and functional complexity. In cases of spinal instability an initial posterior fusion and biopsy appears to be a reasonable first step. As pathology may be wrong initially as in this case, local surgical control via an anterior approach should be a major treatment goal. If negative surgical margins cannot be achieved, regular follow-up will show signs of local recurrence. At the end there is no high evidence for adjuvant radiotherapy in spinal GCT.