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Vol. 32. Issue 5.
Pages 236-240 (September - October 2021)
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Vol. 32. Issue 5.
Pages 236-240 (September - October 2021)
Caso clínico
Tumor vertebral primario de axis: un desafío clínico y quirúrgico
Primary vertebral tumor of axis: A clinical and surgical challenge
Pelayo Hevia Rodríguez
Corresponding author
pelahevia@gmail.com

Autor para correspondencia.
, Joaquín Andermatten, Alejandro Elúa Pinín, Patricia Moreno Moya, Nicolás Samprón, Enrique Úrculo Bareño
Servicio de Neurocirugía, Hospital Universitario Donostia, Donostia, Gipuzkoa, España
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Presentamos el caso de un varón de 17 años que acude a urgencias por cervicalgia de 6 semanas de evolución, sin déficit neurológico. La tomografía y resonancia magnética mostraban una masa dependiente de C2 con infiltración de partes blandas e invasión del canal medular, sin signos de mielopatía. Se realizó biopsia guiada con tomografía. Esperando al resultado, el paciente desarrolló una tetraparesia aguda con incompetencia de esfínteres. Una nueva resonancia magnética mostró un aumento de la masa ósea tumoral con extensión epidural, mielopatía y nuevas lesiones vertebrales. Se realizó una resección posterior y descompresión medular de urgencia, con fijación occipito-cervical. La recuperación postoperatoria fue completa. La inmunohistoquímica reveló un sarcoma de Ewing. Se inició quimioterapia con respuesta parcial. El sarcoma de Ewing primario atlantoaxial es una entidad excepcional con mal pronóstico. Su tratamiento es multidisciplinar, incluyendo una resección total si es posible, lo cual supone un reto para el cirujano.

Palabras clave:
Tumor vertebral
Axis
Sarcoma de Ewing
Cervical
Mielopatía
Abstract

We report the case of a 17-year-old male presented to the emergency department with a six weeks history of neck pain and no neurogical deficit. Computed tomography and magnetic resonance imaging revealed an expansile lesion in the axis, with soft tissue and spinal cavity invasion, without mielopathy signs. Tomography-guided mass biopsy was taken. Waiting for histopathologic results, the pacient developed acute tetraparesis and sphincter incompetence. Magnetic resonance revealed that the bone mass had grown with epidural compromise, mielopathy and new vertebral lesions. Medular decompression with laminectomy, excision of the posterior elements of axis with the involved soft tissue mass and occipito-cervical fixation was performed. Neurological recovery was complete. Inmunochemistry revealed an Ewing Sarcoma. Chemoteraphy treatment was given, with partial response. Primary Ewing sarcoma of atlas-axis is a rare entity with poor prognosis. Multidisciplinary approach treatment is needed, with a total surgical resection if it is possible, a real challenge for the surgeon.

Keywords:
Spine tumor
Axis
Ewing's sarcoma
Cervical spine
Mielopathy

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