Mediclinic Louis Leipoldt neurosurgeon removes rare bone tumour

Mediclinic Louis Leipoldt neurosurgeon Dr Deon Lamprecht, together with Professor Ian Vlok, recently performed a complex surgery to remove a very rare tumour from the C1 vertebra, the top bone in the spine just below the skull.

Dr Lamprecht’s patient, Maureen, aged 48, was referred to him with severe pain at the base of her skull and in her neck, along with headaches. “A neurologist had previously examined her and found a tumour in the first vertebra (C1) near the base of her skull through a brain scan,” Dr Lamprecht explains.

Although she was otherwise healthy with no weakness or loss of function, surgery to remove the tumour was necessary. The tumour, called an aneurysmal bone cyst, is non-cancerous but can cause damage to the surrounding area if left untreated.

Preparing for the procedure

The tumour is very rare, occurring in only about one in 100 000 cases each year. It makes up about 1% of all bone tumours, says Dr Lamprecht. “Where it was located in the C1 vertebrae is exceptionally rare, I haven’t seen that in 30 years of neurosurgery. While such tumours can affect the spine, they most often affect long bones like the femur or the humerus.”

Maureen’s tumour was growing in front of her spinal cord, which made the situation even more complicated.

The tumour was found using CT and MRI scans of Maureen's neck. “Initially there was concern that maybe cancer had spread from somewhere else, so we scanned the rest of the body,” Dr Lamprecht says. “As it was in such an unpleasant location, a biopsy was done through the front of the neck, towards the vertebrae.”

Although benign, the tumour had to be removed through surgery. “Doing nothing was very risky as that bone would either have destroyed her upper spinal cord, or started to cause pressure on it,” Dr Lamprecht explains. He and Professor Vlok carefully planned the surgery well in advance, consulting academics from the University of Cape Town and Tygerberg Hospital for advice.

“We discussed either going through the open mouth, through the back of the throat and then into the vertebrae or coming from behind. We chose the route from behind because we felt we could get around the spinal cord and avoid damaging it.”

Complex surgery

The four-hour surgery was performed on 4 November 2024. The surgeons removed the front part of the C1 vertebra using a back approach and then fused the first three neck vertebrae (C1 to C3) to make the neck more stable. “The C1 vertebrae is where the skull and the neck meet,” Dr Lamprecht explains. “Destruction of that bone implies that the connection between the head and the neck is defective and so we had to fuse the skull to the neck. We did that by putting screws into the back of the head and then attaching those with rods to screws in the neck.”

The surgery carried serious risks to the spinal cord. “There’s also a major blood vessel running across the C1 vertebrae called the vertebral artery, which supplies blood to the brain stem,” he says. “We were very close to that as well.”

However, Maureen wasn’t deterred by the risks, which were explained to her in detail. “I just wanted this tumour out of my body,” she says.

Positioning during the surgery was very delicate, Dr Lamprecht says. Maureen's head had to be secured in a clamp because she couldn’t lie face down for four hours. Lifting her head helped reduce pressure on her eyes. To reach the tumour, the doctors made a small incision in her neck and moved carefully toward it, using X-rays throughout the procedure to guide them.

“Eventually we reached the tumour and cleaned it out from the small shell of bone it was in. This was done right next to the spinal cord and below a critical blood vessel, so we had to work in a very tight space using a microscope.”

Healing process

The surgery was a success. Maureen was able to walk the next day and was discharged within three days. Similar tumours can recur, so she will need ongoing monitoring. But for now, her prognosis is good.

Maureen says she’s immensely grateful to the hospital and surgical team, especially Dr Lamprecht and Professor Vlok. “I cannot thank these two remarkable surgeons enough,” she says. “I feel like I could climb Table Mountain and stand at the top and just say thank you to them for saving my life. I’m recovering very well. I’ve already been for my first check-up with Dr Lamprecht, who was very impressed with the healing process. I’m getting stronger and the pain is easing. I take it one day at a time.”