- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
DOI:10.4103/sni.sni_444_16Copyright: © 2017 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Joham Choque-Velasquez, Roberto Colasanti, Anna Piippo, Mika Niemelä. Suboccipital osteoblastoma: Microsurgical resection of a rare entity. 14-Mar-2017;8:33
How to cite this URL: Joham Choque-Velasquez, Roberto Colasanti, Anna Piippo, Mika Niemelä. Suboccipital osteoblastoma: Microsurgical resection of a rare entity. 14-Mar-2017;8:33. Available from: http://surgicalneurologyint.com/?post_type=surgicalint_articles&p=8314
Background:Osteoblastomas are rare lesions comprising 1% of all bone tumors. The occipital bone is one of the rarest affected bone, with only 11 cases reported during the last 40 years.
Case Description:Here, we describe the clinical presentation and the radiological features of a suboccipital osteoblastoma that was successfully resected in a 30-year-old man. A short video shows the microsurgical removal of the lesion. There was no recurrence during a 12-month follow-up.
Conclusions:Even if osteoblastomas are benign tumors, a complete removal has to be achieved to reduce the risk of recurrences. This makes necessary an appropriate monitoring of the patient.
Keywords: Occipital bone, osteoblastoma, park bench position, suboccipital approach
Osteoblastomas are rare lesions comprising 1% of all bone tumors. Skull bones are affected in only approximately 3% of the cases, and the occipital bone is far less involved than facial, temporal, frontal, and skull base bones.[
A 30-year-old man, without significant medical history, was admitted to our department for a painful left occipitocervical swelling, progressively worsening over the past several months. A physical examination revealed an occipital hard mass covered by the normal skin, without any neurological deficit.
A computerized tomography (CT) scan showed an osteolytic lesion inside the diploic space surrounded by sclerotic tissue expanded to the left squamous portion of the occipital bone around the foramen magnum. In addition, the CT angiography with three-dimensional (3D) reconstruction revealed a close relation between the tumor and the vertebral and occipital arteries [
Preoperative images. (a) Axial CT scan showing a left osteolytic occipital lesion surrounded by sclerotic tissue extended inferiorly up to the foramen magnum. (b and c) 3D reconstructions of the CT angiogram illustrating the close relationship between the tumor and the vertebral and occipital arteries. (d) Sagittal post-contrast T1-weighted MRI scan revealing an avidly enhancing occipital extra-axial mass
The patient underwent a left suboccipital approach in the park bench position. After the dissection of the soft tissues, the lesion was targeted according to anatomic landmarks. Under the operating microscope, the tumor was progressively removed, using high speed drills and rongeurs, up to the normal dura and surrounding normal bone. However, the left occipital condyle was left undisturbed [
Intraoperative photographs. (a) Initial removal of the lesion with a high speed drill. (b) Removal of the lesion using a kerrison rongeur, once the dura is reached, in order to prevent inadvertent dural lacerations. (c) Surgical field at the end of the resection with the surrounding normal bone
The postoperative course was uneventful, and the patient's symptoms disappeared. The histopathological examination was consistent with benign osteoblastoma, and the postoperative CT scan showed the complete resection of the lesion [
Osteoblastomas comprise 1% of all bone tumors. Skull bones are affected in only 3% of the cases, and occipital osteoblastomas are even rarer. To the best of our knowledge, this is the 12th case reported in the last 40 years.[
The presentation of the tumor is more frequent in men less than 30 years old; calvarian osteoblastomas essentially share the same characteristics of the osteoblastomas in other locations,[
Occipital osteoblastomas present as circumscribed expansive intraosseous lesions between the inner and outer table of the occipital bone, with lytic and sclerotic appearance in plain radiographs and CT scans.[
Even though giant osteoid osteomas are reported, unlike osteoblastomas,[
The recurrence of osteoblastomas after surgery is approximately 9.8–15%.[
In summary, occipital osteoblastomas are extreme rare benign bone tumors with typical histological features, sometimes hypervascularized, and with a high tendency to recur when they are not completely resected. At times, their treatment may require presurgical embolization, occipitocervical fusion, and/or transposition of the vertebral artery. Their high risk of recurrence makes necessary an appropriate monitoring of the patient.
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