• Kiyoshi Ito, Takuya Nakamura, Tatsuro Aoyama, Tetsuyoshi Horiuchi, and Kazuhiro Hongo.
• Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan. Electronic address: kitoh@shinshu-u.ac.jp.
• World Neurosurg. 2017 Sep 1; 105: 1043.e15-1043.e19.

BackgroundSeveral surgical approaches for the treatment of pathologies of the craniovertebral junction (CVJ) and high cervical regions have been reported. For the best postoperative results, selection of a surgical route to treat such pathologies should be based on a complete understanding of the approach.Case DescriptionA 64-year-old woman presented with a 5-year history of motor and sensory disturbances in her right upper extremity. Cervical magnetic resonance imaging (MRI) showed a slightly enhanced mass at the C2-C4 level. Sagittal T2-weighted MRI revealed a hyperintense dumbbell-shaped mass involving a damaged C3 vertebral body. We performed a 2-stage operation to achieve gross total removal of the tumor. In the first operation, a posterior approach was used to remove the intracanalicular tumor, achieve spinal cord decompression, and establish a histological diagnosis of the tumor (subsequently diagnosed as a chordoma). In the second operation, gross total removal of the chordoma was achieved via the anterior high cervical retropharyngeal approach. We used iliac bone and titanium plates for the bony fusion.ConclusionsOur results indicate that the high cervical retropharyngeal approach is a reasonable option for pathologies located in the anterior or anterolateral portions of high cervical regions. This approach is an alternative to the transoral approach to the ventral CVJ and high cervical regions.Copyright © 2017 Elsevier Inc. All rights reserved.

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