Surgical treatment of a clival-C2 atypical teratoid/rhabdoid tumor

J Neurosurg Pediatr.

January 1, 2010
Gregory G. Heuer, M.D., Ph.D., Heather Kiefer, B.S., Alexander R. Judkins, M.D., Jean Belasco, M.D., Jaclyn A. Biegel, Ph.D. Eric M. Jackson, M.D., Marc Cohen, M.D., Bert W. O’Malley, Jr., M.D., and Phillip B. Storm, M.D.


Abstract The authors present the case of en bloc resection of a clival-C2 atypical teratoid/rhabdoid tumor. These aggressive lesions of early childhood generally occur in the cerebellum or cerebral hemispheres. This 7-year-old boy presented with pain on turning his head and was found to have a clival-C2 mass. A metastatic workup was negative for disseminated disease. A transoral biopsy procedure revealed an atypical teratoid/rhabdoid tumor on histological examination. The tumor was resected via a transoral approach, and the patient’s spine was stabilized with posterior instrumented fusion from the occiput to C-5. Postoperatively, the patient underwent 16 months of chemotherapy along with 6 weeks of overlapping radiation therapy. Twenty-seven months after the initial surgery he presented with leg pain and was found to have a solitary metastatic lesion at the conus medullaris. There was no local recurrence at the clivus. The conus tumor was resected and found to be consistent with the primary tumor. Several months later the patient presented with disseminated intrathecal disease and ultimately died 42 months after the initial resection. Keywords medulloblastoma; transoral approach; clivus; atypical teratoid/rhabdoid tumor