• Steven O Tenny, Landon D Ehlers, J Will Robbins, and Christopher C Gillis.
• Department of Surgery, Division of Neurosurgery, Nebraska Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA. Electronic address: steven.tenny@unmc.edu.
• World Neurosurg. 2017 Dec 1; 108: 993.e1-993.e7.

BackgroundChordomas arise from remnants of the notochord and occur throughout the neuroaxis. En bloc resection of chordomas can prove especially challenging in the upper cervical spine secondary to the unique structural anatomy and intimate relationship to the vertebral arteries and spinal cord.Case DescriptionWe describe the resection of a C2-C3 chordoma in a 55-year-old woman in 2-stage fashion with preservation of the vertebral arteries. First, a posterior instrumented fusion and removal of the posterior elements was performed, followed by an anterior transmandibular en bloc resection with cage reconstruction with kick-plate support achievable with off-the-shelf products.ConclusionsChordomas in the upper cervical spine pose a surgical challenge but are amenable to en bloc resection. With careful planning and intraoperative adaptability, the surgeon can achieve a suitable reconstruction with off-the-shelf products.Copyright © 2017 Elsevier Inc. All rights reserved.

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