Craniocervical abnormalities

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Abstract
Guidelines are proposed for surgical management of symptomatic abnormalities of the craniocervical junction. Experience with 17 recent cases is described. Gas or metrizamide (Amipaque) myelograms with pluridirectional tomograms revealed the etiology and mechanisms of compression of the cervicomedullary junction and its reducibility. Stabilization was the goal in treatment of reducible lesions. Decompression of the cervicomedullary junction was paramount in irreducible cases. Ventral compression was treated in 9 patients by transoral transpalatine resection of the odontoid-clivus complex and all improved. A posterior decompression was carried out when bone impingement was present from the dorsal aspect. Spinal fusion was performed in cases in which stability was not achieved by either procedure.