“En Bloc” upper cervical spine malignant tumor resection for the first time in Lebanon
The Department of Surgery at the American University of Beirut Medical Center (AUBMC) performed successfully the first-of-its-kind surgery for resecting an upper cervical spine malignant tumor in its entirety (en bloc). This procedure not only increases the success rate but also reduces the risk of recurrence, providing patients a better quality of life.
The surgery was performed by Dr. Ibrahim Omeis, Associate Professor of Clinical Surgery, Neurosurgeon, Division of Neurosurgery, Department of Surgery at AUBMC, with Dr. Roger Moukarbel, Associate Professor of Head and Neck Oncologic and Plastic Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery at AUBMC, and Dr. Aghiad Al-Kutoubi, interventional neuro-radiologist with the support of a multidisciplinary team to ensure its success.
The procedure was decided upon when the patient, a 62 year old female, presented with neck pain radiating down her right upper extremity. Upon reviewing the MRI of the cervical spine, a growing tumor in the upper cervical spine originating from the upper vertebral bodies and encroaching on the right nerve root was spotted. The differential diagnosis included a type of sarcoma (chordoma). Given the location and the complexity of the case, the process needed to be staged. The first stage depended on occluding one of the feeding arteries on the right. During the second stage, we had to free the spinal cord and nerves from a posterior approach along with stabilization of the spinal column. This was followed by a third stage whereby the tumor was delivered from the right side of the neck before the reconstruction of the spinal column was done to ensure the stabilization of the neck. The patient did very well post- operatively, and a month later, she resumed a normal life.
Surgical management for the upper cervical spine malignant tumors are considered to be very complex. Moreover, their location around the spinal cord and feeding arteries to the brain, make the surgical approach and technique of tumor resection and fixation more complicated. In this case, it requires high precision in order to avoid neurological deficit such as strokes or paralysis and even feeding or voice problems. Very few surgeons in the world can perform such a procedure. Usually these procedures require a world class hospital that can provide the necessary equipment and collaboration among different specialties that have the experience to deliver a successful outcome,” said Dr. Omeis. “With another first, AUBMC is proving again its ability to perform the most complex surgeries to its patients utilizing its state-of-the-art equipment and world class skills with multi-team approach and coordination. This marks great hope for patients suffering from spine diseases.”
In such procedures, outcome depends greatly on the age and overall health of the patient and on whether the spinal tumor is benign or malignant, primary or metastatic. In the case of primary tumors, the goal is to remove the tumor completely and en bloc (one piece), leading optimally to the potential cure of the malignancy. In the case of metastatic tumors, the goal is almost always palliative, with treatment aimed at providing the patient with an improved quality of life and possibly prolonged life expectancy.