Transoral Resection of a Giant Cell Tumor in the Odontoid With Cementoplasty: A Technical Case Report.

BACKGROUND AND IMPORTANCE: Giant cell tumors (GCT) are rare neoplasms that primarily affect the long bones, with cervical spine involvement being uncommon, particularly at the C2 level. Although GCTs are considered benign, their aggressive growth patterns and high recurrence rates present significant treatment challenges, making aggressive tumor resection the treatment of choice. Using bone cement to fill the resection cavity has been associated with reduced tumor recurrence. Using a transoral approach provides an optimal surgical corridor for achieving an ideal exposure of such lesions at the anterior craniocervical junction.

CLINICAL PRESENTATION: A 23-year-old man presented with persistent atraumatic neck pain and no neurological deficits. Imaging revealed an osteolytic lesion in the dens, confirmed as a GCT through a transoral biopsy. To prevent spinal instability, posterior stabilization with a C1 to C4 instrumentation was performed, followed by endovascular embolization of arterial tumor feeders. Tumor resection was achieved through a transoral approach, supported by neuronavigation and intraoperative cone-beam computed tomography imaging. The resection cavity was filled with bone cement, and the construct was further stabilized using a vertical inline plate.

CONCLUSION: The transoral approach proved to be an effective and minimally invasive route for resecting the GCT at the odontoid in this case. Postoperatively, the patient experienced mild, transient dysphagia without neurological deficits. Cementoplasty of the odontoid proved to be a safe and effective procedure in this case, with the use of neuronavigation and intraoperative cone-beam computed tomography providing valuable feedback for the surgeon.