{"id":341357,"date":"2016-06-24T02:00:00","date_gmt":"2016-06-24T00:00:00","guid":{"rendered":"https:\/\/medizinonline.com\/approche-interdisciplinaire-dun-chordome-de-la-jonction-cranio-cervicale\/"},"modified":"2016-06-24T02:00:00","modified_gmt":"2016-06-24T00:00:00","slug":"approche-interdisciplinaire-dun-chordome-de-la-jonction-cranio-cervicale","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/fr\/approche-interdisciplinaire-dun-chordome-de-la-jonction-cranio-cervicale\/","title":{"rendered":"Approche interdisciplinaire d&#8217;un chordome de la jonction cr\u00e2nio-cervicale"},"content":{"rendered":"<p><strong><em>Description du cas :<\/em> Nous rapportons le cas d&#8217;un patient de 31 ans qui a fait l&#8217;objet d&#8217;une consultation m\u00e9dicale en raison de l&#8217;apparition r\u00e9cente de douleurs cervicales \u00e0 l&#8217;effort sans sympt\u00f4mes neurologiques concomitants.  <\/strong><\/p>\n<p> <!--more--> <\/p>\n<p>L&#8217;imagerie IRM r\u00e9alis\u00e9e a r\u00e9v\u00e9l\u00e9 une masse intraosseuse dans la jonction cranio-cervicale <strong>(Fig.&nbsp;1), <\/strong>qui correspondait le mieux, en termes de morphologie d&#8217;image, \u00e0 un chordome. Pour confirmer le diagnostic, une biopsie transorale a \u00e9t\u00e9 r\u00e9alis\u00e9e, confirmant la suspicion de chordome [1].<\/p>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\" size-full wp-image-7200\" alt=\"\" src=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2016\/06\/abb1_np3_s36.jpg\" style=\"height:585px; width:400px\" width=\"870\" height=\"1273\"><\/p>\n<p><strong>Diagnostic par IRM et scanner :<\/strong>  Les s\u00e9quences pond\u00e9r\u00e9es en T2 ont montr\u00e9 une masse hyperintense dans le clivus avec une extension sur l&#8217;os occipital au niveau du foramen magnum et sur les condyles occipitaux ainsi que sur l&#8217;atlas dans le dens et le corps de l&#8217;axis.  <strong>(Fig.&nbsp;2 et 3).  <\/strong>La masse s&#8217;\u00e9tendait ventralement jusqu&#8217;\u00e0 l&#8217;art\u00e8re carotide interne extracr\u00e2nienne droite au niveau du foramen magnum et pr\u00e9sentait un large contact avec le foramen jugulaire et la veine jugulaire droite. L&#8217;art\u00e8re vert\u00e9brale a \u00e9t\u00e9 mur\u00e9e des deux c\u00f4t\u00e9s par la masse \u00e0 la hauteur de HWK 2, plus \u00e0 gauche qu&#8217;\u00e0 droite. La masse spatiale pr\u00e9sentait un fort enrichissement en produit de contraste, quelque peu inhomog\u00e8ne. L&#8217;examen tomodensitom\u00e9trique compl\u00e9mentaire a r\u00e9v\u00e9l\u00e9 que la masse \u00e9tait une ost\u00e9olyse \u00e9tendue sans calcifications.<\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-7201 lazyload\" alt=\"\" data-src=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2016\/06\/abb2_np3_s36.jpg\" style=\"--smush-placeholder-width: 886px; --smush-placeholder-aspect-ratio: 886\/866;height:586px; width:400px\" width=\"886\" height=\"866\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\"><\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-7202 lazyload\" alt=\"\" data-src=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2016\/06\/abb3_np3_s37.jpg\" style=\"--smush-placeholder-width: 857px; --smush-placeholder-aspect-ratio: 857\/1036;height:725px; width:400px\" width=\"857\" height=\"1036\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\"><\/p>\n<p><strong>D\u00e9roulement :<\/strong> En raison de l&#8217;infiltration et de l&#8217;ost\u00e9olyse \u00e9tendues des structures osseuses \u00e0 la jonction cranio-cervicale, une stabilisation par voie dorsale \u00e9tait n\u00e9cessaire avant la r\u00e9section pr\u00e9vue de la tumeur. Dans un premier temps, les orthop\u00e9distes ont r\u00e9alis\u00e9 une fusion occipito-cervicale en utilisant un syst\u00e8me de plaques et de vis dorsales <strong>(Fig. 4).<\/strong> Au cours de la m\u00eame op\u00e9ration, des parties du chordome entourant l&#8217;art\u00e8re vert\u00e9brale ont pu \u00eatre r\u00e9s\u00e9qu\u00e9es des deux c\u00f4t\u00e9s.<\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-7203 lazyload\" alt=\"\" data-src=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2016\/06\/abb4_np3_s37.jpg\" style=\"--smush-placeholder-width: 863px; --smush-placeholder-aspect-ratio: 863\/1213;height:843px; width:400px\" width=\"863\" height=\"1213\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\"><\/p>\n<p>Neuf jours plus tard, la r\u00e9section compl\u00e8te combin\u00e9e transnasale-transorale du chordome a \u00e9t\u00e9 r\u00e9alis\u00e9e avec une technique endoscopique assist\u00e9e par les coll\u00e8gues de l&#8217;ORL et de la neurochirurgie. Une r\u00e9section compl\u00e8te du chordome a ainsi pu \u00eatre obtenue. Les contr\u00f4les IRM postop\u00e9ratoires ont confirm\u00e9 la r\u00e9section compl\u00e8te <strong>(Fig.&nbsp;5).<\/strong> L&#8217;\u00e9volution clinique postop\u00e9ratoire s&#8217;est d\u00e9roul\u00e9e sans complications. Apr\u00e8s un bon mois et demi d&#8217;hospitalisation, le patient a pu rentrer chez lui sans sympt\u00f4mes et une radioth\u00e9rapie adjuvante a \u00e9t\u00e9 planifi\u00e9e. L&#8217;IRM de contr\u00f4le \u00e0 six mois n&#8217;a r\u00e9v\u00e9l\u00e9 aucune r\u00e9cidive.<\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-7204 lazyload\" alt=\"\" data-src=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2016\/06\/abb5_np3_s37.jpg\" style=\"--smush-placeholder-width: 877px; --smush-placeholder-aspect-ratio: 877\/1203;height:549px; width:400px\" width=\"877\" height=\"1203\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\"><\/p>\n<p><strong>Conclusion :<\/strong> l&#8217;\u00e9troite collaboration interdisciplinaire entre la neuroradiologie, l&#8217;orthop\u00e9die, l&#8217;ORL et la neurochirurgie a permis d&#8217;atteindre l&#8217;objectif d&#8217;une r\u00e9section compl\u00e8te de ce chordome complexe \u00e0 la jonction cranio-cervicale.<\/p>\n<p>&nbsp;<\/p>\n<p>Litt\u00e9rature :<\/p>\n<ol>\n<li>Choi D, et al. : R\u00e9sultat de 132 op\u00e9rations chez 97 patients atteints de chordomes de la jonction craniocervicale et de la colonne cervicale sup\u00e9rieure. Neurosurgery 2010 ; 66(1) : 59-65.<\/li>\n<\/ol>\n<p>\n<em>InFo NEUROLOGIE &amp; PSYCHIATRIE 2016 ; 14(3) : 36-37<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Description du cas : Nous rapportons le cas d&#8217;un patient de 31 ans qui a fait l&#8217;objet d&#8217;une consultation m\u00e9dicale en raison de l&#8217;apparition r\u00e9cente de douleurs cervicales \u00e0 l&#8217;effort&hellip;<\/p>\n","protected":false},"author":7,"featured_media":56669,"comment_status":"closed","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"pmpro_default_level":"","cat_1_feature_home_top":false,"cat_2_editor_pick":false,"csco_eyebrow_text":"Patient de 31 ans pr\u00e9sentant des douleurs cervicales d'effort r\u00e9centes","footnotes":""},"category":[11394,11541,11399,11383,11448,11549],"tags":[42020,42026,27007],"powerkit_post_featured":[],"class_list":["post-341357","post","type-post","status-publish","format-standard","has-post-thumbnail","category-anesthesiologie","category-cases-fr","category-chirurgie-fr","category-neurologie-fr","category-orl-fr","category-rx-fr","tag-chordome-fr","tag-douleur-au-cou","tag-irm","pmpro-has-access"],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-06-27 17:39:08","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"wpml_current_locale":"fr_FR","wpml_translations":{"it_IT":{"locale":"it_IT","id":341365,"slug":"approccio-interdisciplinare-a-un-cordoma-della-giunzione-cranio-cervicale","post_title":"Approccio interdisciplinare a un cordoma della giunzione cranio-cervicale","href":"https:\/\/medizinonline.com\/it\/approccio-interdisciplinare-a-un-cordoma-della-giunzione-cranio-cervicale\/"},"pt_PT":{"locale":"pt_PT","id":341327,"slug":"abordagem-interdisciplinar-de-um-acordeoma-da-juncao-craniocervical","post_title":"Abordagem interdisciplinar de um acordeoma da jun\u00e7\u00e3o craniocervical","href":"https:\/\/medizinonline.com\/pt-pt\/abordagem-interdisciplinar-de-um-acordeoma-da-juncao-craniocervical\/"},"es_ES":{"locale":"es_ES","id":341342,"slug":"abordaje-interdisciplinar-de-un-cordoma-de-la-union-craneocervical","post_title":"Abordaje interdisciplinar de un cordoma de la uni\u00f3n craneocervical","href":"https:\/\/medizinonline.com\/es\/abordaje-interdisciplinar-de-un-cordoma-de-la-union-craneocervical\/"}},"_links":{"self":[{"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/posts\/341357","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/comments?post=341357"}],"version-history":[{"count":0,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/posts\/341357\/revisions"}],"wp:attachment":[{"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/media?parent=341357"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/category?post=341357"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/tags?post=341357"},{"taxonomy":"powerkit_post_featured","embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/powerkit_post_featured?post=341357"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}