DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20181787

Metastases to the craniovertebral junction: illustrative case report and review of literature

Chandramouleeswaran Venkatraman, Sindhuja Lakshminarasimhan, Pratheep Kumar S., Krishnaprasad Thuvarapalayam Periasamy

Abstract


Metastases at the craniovertebral junction represent 0.5-1% of spinal metastatic lesions. Common primary sites include breast, lung and prostate carcinoma. Initial presenting features include neck pain and occipital neuralgia. High index of suspicion is required to recognize this entity in patients presenting with neck pain. If left unrecognized, these metastatic lesions have the propensity to cause catastrophic collapse leading to significant morbidity and mortality due to fracture subluxation and spinal cord compression. Here we discuss such a patient who presented with acute onset quadriparesis and lower cranial nerve palsies due to metastatic lesion involving the C1 and C2 vertebra causing medullary and cervical cord compression. Early detection and timely intervention are key to improving outcomes in such patients.


Keywords


Craniovertebral junction, Quadriparesis, Metastases

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References


Phillips E, Levine AM. Metastatic lesions of the upper cervical spine. Spine (Phila Pa 1976). 1989;14:1071-7.

Sundaresan N, Boriani S, Rothman A, Holtzman R. Tumors of the osseous spine. J Neurooncol. 2004;69:273-90.

Guillevin R, Vallee JN, Lafitte F et-al. Spine metastasis imaging: review of the literature. J Neuroradiol. 2007;34:311-21.

Moulding HD, Bilsky MH. Metastases to the craniovertebral junction. Neurosurgery. 2010;66:113-8.

Nakamura M, Toyama Y, Suzuki N, Fujimura Y. Metastases to the upper cervical spine. J Spinal Disord. 1996;9:195-201.

George B, Archilli M, Cornelius JF. Bone tumors at the cranio-cervical junction. Surgical management and results from a series of 41 cases. Acta Neurochir (Wien). 2006;148:741-9.

Xu R, Sciubba DM, Gokaslan ZL, Bydon A. Metastasis to the occipitocervical junction: A case report and review of the literature. Surg Neurol Int. 2010;31:1-16.

Serban, N.A. Calina, Fl. Exergian, M. Podea, C. Zamfir, E. Morosanu, et al. The upper cervical spine tumor pathology C1-C2-therapeutic attitude. Romanian Neurosurg. 2012;XIX 4:251-63.

Ni X, Wu P, Wu C, Wu J, Ji M, Gu X, Tian B. Treatment of cervical vertebral (C1) metastasis of lung cancer with radiotherapy: A case report. Oncol Lett. 2013;5:1129-32.

Baker JF, Shafqat A, Devitt A, McCabe JP. Stabilization of metastatic lesions affecting the second cervical vertebra. J Craniovertebr Junction Spine. 2015;6:56-9.

Azad TD, Esparza R, Chaudhary N, Chang SD. Stereotactic radiosurgery for metastasis to the craniovertebral junction preserves spine stability and offers symptomatic relief. J Neurosurg Spine. 2015;30:1-7.