Elsevier

World Neurosurgery

Volume 79, Issue 1, January 2013, Pages 207.e15-207.e18
World Neurosurgery

Peer-Review Short Report
Occiput to Thoracic Fusion After Surgical Resection of Desmoid Tumor

https://doi.org/10.1016/j.wneu.2011.01.041Get rights and content

Background

Desmoid tumors are rare clinical entities that cause significant morbidity based on their locally aggressive nature. Complete resection with wide margins is the standard of care; however, when arising in the neck, resection is limited due to proximity of the lesion to critical structures.

Case Description

We describe a complete resection of a desmoid tumor requiring extensive resection of cervical extensor musculature. We were able to achieve a total resection of a cervical desmoid tumor with no evidence of recurrence at follow-up.

Conclusions

Complete resection of desmoid tumors is the standard of care. In this case, we felt that complete resection would lead to iatrogenic instability; therefore, an occiput to thoracic fusion was performed at the time of the resection.

Introduction

Desmoids are an uncommon (2–4 cases/million) and slow growing group of tumors that originate from the muscle spindle cell (16). They occur in a wide age range, from 16 to 79 years with a median age of 35 years and tend to be more common in women with no differences by race (14, 16). One third of all desmoids occur outside of the abdomen, and of these 10% to 25% occur in the head and neck, mostly in the anterolateral portion (15). When arising in the neck, common symptoms include local pain, radicular pain, or weakness in the upper extremity from root or plexus involvement (2). The goal of surgery is complete resection with negative margins; however, in the neck this is limited by proximity to vital structures. Without a complete resection, time to recurrence has been reported from 4 months to 12 years, with a median time to recurrence of 18 months (7).

Section snippets

History and Examination

A 25-year-old woman initially presented to the Department of Head and Neck Surgery at the University of Miami with a painful, slowly enlarging posterior neck mass. The mass was round, firm, and fixed to the underlying tissue and was painful to palpation. The patient was neurologically intact with no radicular pain or weakness. Magnetic resonance image revealed a large posterior paraspinal soft tissue mass with heterogenous enhancement extending from the suboccipital region to, and slightly

Discussion

Desmoids are typically sporadic in origin; however. some can arise in association with familial adenomatous polposis (16). There are no pathognomonic imaging characteristics. On T1-weighted imaging, the lesions are typically isointense to muscle tissue, and on T2-weighted imaging, the lesions are hyperintense and intermediate between muscle and fat. Magnetic resonance imaging is superior to computerized tomography and helps to differentiate muscle, fat, and tumor (3, 5). The tumor may also show

Conclusion

We present the case of a posterior cervical desmoid tumor with fairly symmetric involvement of bilateral cervical extensor musculature requiring radical resection. We performed an occiput to thoracic fusion with excellent results and no evidence of recurrence at 18 months (Figure 3, Figure 4, Figure 5). Our follow-up, however, is incomplete, and the patient continues to undergo surveillance imaging. En-bloc resection of desmoid tumors should be used whenever possible; in our patient it involved

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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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