A 61-year-old woman with a history of pharmacologically controlled arterial hypertension and two episodes of right maxillary sinusitis treated medically four and two years prior to the current problem. No known allergies and no previous surgical interventions. In April 1999, he presented with a right laterocervical subcutaneous tumour at the level of the angle of the mandible, which was initially related to a case of acute otitis that had occurred two months earlier. Since the appearance of the lump, he has reported moderate cervical pain which is accentuated by rotational movements.
In June of the same year, she reported dysaesthesia in the shoulder and right upper limb associated with cervical pain, as well as ipsilateral C2 neuralgia.
Examination: a well-defined rubbery tumour was observed in the right mandibular angle adhering to deep planes and moderately painful on palpation. There is no alteration of the long pathways and the cranial nerves are bilaterally preserved.
Investigations: a complete blood test revealed no abnormalities. A cervical MRI was performed, showing a space-occupying lesion occupying the right conjunctival foramen of C2-C3 with enlargement and erosion of the lateral mass of the axis, as well as the right posterior interapophyseal joint. Occupation of the anterolateral recess of the spinal canal is observed, but without distortion of the spinal cord. Anteriorly it distorts, displaces and collapses the right vertebral artery and contacts the carotid bifurcation and the internal jugular vein without affecting them. It also distorts the laterocervical musculature, but without infiltrating it.

A CT scan was then performed, showing more clearly an erosion of the lateral mass of C2. Finally, an angiography of the supra-aortic trunks demonstrates occlusion of the right vertebral inflow.

Management: in April 2000, in conjunction with the ENT department, a subtotal resection of the tumour was performed via the lateral cervical approach in order to obtain a histological diagnosis and reduce the tumour mass. The procedure passed without incident and the patient was discharged five days later. The patient remained asymptomatic.
Once the diagnosis of a well-differentiated grade I chondrosarcoma had been obtained, the patient was readmitted one month later to attempt to complete the resection via the posterior approach and to stabilise the upper cervical spine by means of occipito-cervical instrumented fixation. During the procedure, which was successful, a tumour was observed that eroded, insufflated and invaded the articular massifs of C2 and C3 on the right and their respective haemilamina. Invasion of the right hemibody of the axis is also observed. The vertebral artery is thrombosed. The roots of the right C2 and C3 are undamaged and the dural sac is free. The instrumentation performed consisted of transpedicular screwing of left C2 electively, according to the Goel4 technique, with cranial extension by anchoring three screws in the occipital scala bilaterally, and with caudal extension with screwing in the lateral mass of left C3 and right lateral mass of C4. Subtotal excision is achieved. The postoperative course was completely satisfactory, with the postoperative control X-ray showing correct fixation. The patient was discharged home nine days later and referred to the radiotherapy department, where a course of 50 Gy was administered as adjuvant treatment.

Evolution: in April 2002 the presence of a right laterocervical adenopathy was noted. A new MRI study confirmed tumour recurrence. The lymphadenopathy was excised and histological analysis confirmed the presence of recurrence, and brachytherapy with 40 Gy was carried out.
In March 2003 a new tumour increase was observed; a new surgical intervention was decided, after demonstrating the absence of distant disease. On this occasion a transcervical lateral suprahyoid approach was performed with subtotal resection. Elective tracheostomy was also performed. Both procedures were uneventful.
Unfortunately, three months later new tumour growth was confirmed again, coinciding with pain in the left hemifacial region radiating to the left upper extremity, and symptomatic treatment was decided. In December 2003, coinciding with the presence of motor difficulties in both upper limbs, new tumour growth was confirmed radiologically. On this occasion a new surgical intervention was rejected and it was decided to administer chemotherapy following a scheme of adriamycin + ifosfamide. After two cycles, treatment was abandoned due to poor response and high toxicity.
