A 66-year-old woman presented with cervical pain.
Two years later paresthesias in the left upper limb and headache were added.
MRI revealed a craniocervical mass that was biopsied through the cavum.
The pathological study corresponds to a plasma cell tumor.
The tumoral extension study showed no other alterations.
She was treated with chemotherapy and radiotherapy (4 cycles of Vincristine-Adriamycin-Dexamethasone + 46.8 Gy).
After receiving this treatment the tumor remission is complete, but the patient begins with tetraparesis, vertebra and dysphagia.
Skull-cervical instability with brainstem injury is diagnosed and occipitocervical fixation is indicated.
Surgery was performed in a concordant position, with a 3Kg cranial traction in slight flexion that allowed a modest reduction in the basilary impression.
A small suboccipital craniectomy was performed with excision of the posterior arch of the atlas.
It was instrumented with the Olerud® system (Anatomica, Gothenburg, Sweden) and transarticular screw C1-C2 according to the Magerl7 technique.
When the right transarticular screw was placed, the vertebral artery was injured and hemostasis was achieved with the complete introduction of the screw.
There was no increase in neurological deficits in the immediate postoperative period; however, this was complicated by upper gastrointestinal bleeding and pulmonary aspergillosis.
The patient responded favorably to medical treatment of these complications and was discharged home.
A month later she was admitted for dysphasia.
Two brain lesions were biopsied.
The diagnosis of these lesions was cerebral aspergilloma.
After two years of follow-up, the patient was successfully treated with medical treatment and survived with residual pyramidal syndrome.
