PMC8720446_01
Pre-operative studies. (a) C3 CT bone window, (b) C4 CT bone window, (c) C3 T2-weighted MRI, right VA white arrow head, (d) C4 T2-weighted MRI, right VA white arrow head, E) cervical spine CT bone window, (f) cervical spine T2-weighted MRI, (g) cervical myelo-scan. CT: Computed tomography, VA: Vertebral artery, MR: Magnetic resonance.
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F1
Bone window CT demonstrated lytic lesion of the body and right transverse foramen of C3 and C4 [Figure 1].
Microscopic images. Hematoxylin and eosin stain. (a) Low power view (x5) Chondroid chordoma. Neoplastic epithelioid cells with eosinophilic to clear, bubbly cytoplasm arranged in nests, sheets, and individual in a myxoid stroma. (b) Hematoxylin and eosin stain. High power view (x40) Red circle demonstrates cells with vesicular chromatin and bubbly to vacuolated cytoplasm called physaliphorous cells. (c) Hematoxylin and eosin stain. High power view (x40) Physaliphorous cells reside in abundant myxoid stroma.
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F2
Pathology was consistent with a chordoma [Figure 2].
Right vertebral artery angiogram, anterior view. White arrow showing filling defect, due to tumoral compression, at C3-C4 level.
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F3
A preoperative angiogram was performed to evaluate the patency and dominance of both the compromised right VA and contralateral VA [Figure 3].
Cervical X-ray showing placement of expandable cage and anterior plate. (a) Anterior view, (b) lateral view.
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F4
Resection of the PLL was performed and a C2-C5 fusion was achieved using an expandable titanium cage and anterior cervical plate [Figure 4].
PMC8720446_02
Artist representation. (a) pre-operative illustration. (b) post-operative illustration.
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F5
Artist representation (Figure 5).