Actuarial survival rate was 80 and 65 % respectively at 5 and 10 years in group A as compared to 50 and 0% in group B. Actuarial recurrence free rate was 70 and 35% at 5 and 10 years in group A and 0% at 3 years in group B. Disease related mortality was 15% in group A and 63% in group B. The rate of recurrence per year was 0,15 in group A and 0,62 in group B. The mean delay before the first recurrence was 43 months in group A and 15 months in group B. Factors such as sex, age, duration of symptoms, severity of symptoms, extent of tumor, histological type or grading have no influence on the survival rate and the recurrence free rate. Even the comparison between patients having received or not radiotherapy and patients treated or not by protontherapy failed to show any difference. However these groups of patients are very small and include group A and group B patients.
Complete tumor resection was achieved in every case especially for the lateral part located into the intervertebral foramen and around the vertebral artery. Even tumors extending from the outside of the spine to the intradural space could be entirely removed through the same approach. Grafting and plating were realized in 13 out of the 126 cases of tumor.
The anterolateral approach is a superior extension of the lateral approach used to control the VA from the C6 to C2 levels. The field is opened between the sternomastoïd muscle and the internal jugular vein. Then the VA is exposed between C1 and C2 transverse processes and above C1. It is essentially applied on extradural and bony lesions around the CCJ.
Anterolateral approach was used on 139 patients with different types of tumors including neuromeningeal tumors N=36, primary bone tumors N=51, sarcoma N=16 and others types N=21, and on 3 cases of VA compression by bone malformations. Satisfying tumoral resection could be achieved in almost all cases. Sacrifice of the VA was deliberately realized in 5 patients to ensure as radical a resection as possible in case of malignant tumors or chordomas. There was no mortality in this series. Morbidity is very limited; injury of the VA was observed in two cases in which repair of the vessel could be done successfully. Stretching of the XI nerve was the cause of pain along the trapezius muscle in 5 patients.