Resection of C3 osteochondroma in a 20-year-old male with the combination of virtual reality and 3D printing for preoperative planning: illustrative case.

backgroundWhile osteochondromas are the most common benign bone tumors, spinal involvement remains uncommon. In patients with hereditary multiple exostosis (HME), spinal osteochondromas predominantly affect posterior elements. Anterior vertebral body involvement is unusual, and anterior C3 osteochondroma with parapharyngeal extension in an adult has not been previously reported in the literature. Management of complex anterior cervical tumors near critical neurovascular structures presents significant surgical challenges. OBSERVATIONS: The authors present the first documented case of anterior C3 vertebral body osteochondroma with parapharyngeal space extension in a 20-year-old patient with HME presenting with progressive dysphagia. Preoperative imaging and advanced surgical planning utilizing patient-specific 3D-printed models and immersive virtual reality (VR) enabled detailed visualization of tumor anatomy. Intraoperative fluoroscopic volumetric navigation was used to guide precise osteotomy cuts in proximity to the vertebral artery. Complete tumor resection was achieved without neurological or vascular complications and without breach of the upper aerodigestive tract, with complete resolution of dysphagia and no recurrence at the 3-month follow-up. LESSONS: Advanced preoperative planning using 3D printing and VR provide significant value for rare and anatomically complex spinal pathology, especially when multiple surgical services are involved. The addition of intraoperative volumetric navigation enabled safe resection of the tumor adjacent to critical neurovascular structures. https://thejns.org/doi/10.3171/CASE26134.