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Vol. 20. Issue 5.
Pages 478-483 (January 2009)
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Vol. 20. Issue 5.
Pages 478-483 (January 2009)
Plasmocitoma de base craneal con inestabilidad cráneo-cervical
Skull base plasmacytoma with craniocervical instability
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N. Samprón
, M. Arrazola, E. Urculo
Servicio de Neurocirugía. Hospital Donostia. San Sebastián. España
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Resumen
Introducción

La inestabilidad cráneo-cervical constituye, en ocasiones, el principal problema neuroquirúrgico en la patología tumoral de la base craneal posterior. Presentamos un caso clínico en el que un plasmocitoma solitario originó inestabilidad cráneocervical. Durante la cirugía de estabilización, se lesionó la arteria vertebral. Revisamos la anatomía quirúrgica desde el punto de vista de la prevención de las complicaciones vasculares.

Caso clínico

Mujer de 66 años diagnosticada de plasmocitoma solitario de base craneal, tratada con radio y quimioterapia con remisión completa, que presenta tetraparesia y disfagia. Tras el diagnóstico de inestabilidad cráneo-cervical, se indica estabilización mediante instrumentación occipito-cervical. Es intervenida bajo tracción craneal con atornillado C1-C2 según técnica de Magerl y extensión occipital. Durante la cirugía se lesionó la arteria vertebral derecha sin repercusión clínica. Dos años más tarde, la paciente es capaz de llevar una vida independiente.

Conclusiones

La instrumentación cráneo-cervical con tornillos transarticulares C1-C2, como parte del sistema de fijación C0-C1-C2, parece eficaz para corregir la inestabilidad en lesiones osteolíticas, a expensas de un riesgo considerable de lesión de la arteria vertebral, especialmente en presencia de algunas variaciones anatómicas.

Palabras clave:
Base craneal
Plasmocitoma solitario
Inestabilidad cráneo-cervical
Arteria vertebral
Instrumentación
Summary
Introduction

Cranio-cervical instability is, in some cases, the main surgical concern in posterior skull base tumors. We report on a case in which a solitary plasmacytoma of the skull base presented with cranio-cervical instability. Vertebral artery was injured during surgery. The surgical anatomy is reviewed, with emphasis in vascular complications avoidance.

Case report

A 66 year-old woman was diagnosed of a cranial base solitary plasmacytoma and treated with radio and chemotherapy with complete remission. After receiving that treatment, she presented with tetraparesis and a cranio-cervical instability was diagnosed. She was operated on, under cranial traction, of posterior occipito-cervical instrumentation with C1 to C2 transarticular Magerl screws. The right vertebral artery was injured during surgery without additional neurological deficit. Two years after the operation she remains independent for daily activities.

Conclusions

Transarticular screws at the C1 to C2 level of the cervical spine may provide rigid fixation in posterior cranio-cervical instrumentation for osteolytic lesions, but there is a risk of injury to the vertebral artery, specially when some variations in the surgical anatomy exist.

Key words:
Skull base
Solitary plasmacytoma
Craniocervical instability
Screw
Vertebral artery

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