Microsurgical odontoidectomy via transoral transpharyngeal approach for craniovertebral junction malformation

Objective To study the microsurgical odontoidectomy via transoral transpharyngeal approach for craniovertebral junction malformation and its safety. Methods Craniovertebral junction malformation in 85 consecutive patients was treated with microsurgical odontoidectomy via transoral transpharyngeal approach for ventral neural decompression in our hospital from January 1, 2006 to December 31, 2008. Of the 85 patients, 69 had fixed atlantoaxial dislocation combined with or without basilar invagination and 16 had basilar impression. MR imaging showed anterior compression on brain stem and superior cervical spine in all patients, hindbrain impression in 44 patients, and syringomyelia in 36 patients. All the patients underwent microsurgical odontoidectomy via transoral transpharyngeal approach for the ventral neural decompression. Results Good recovery and improvement were found in 83 patients immediately after the operation, the remaining 2 patients had no clinical improvement because of the incomplete decompression. Cerebrospinal fluid leakage occurred in 4 patients and stopped 1 week after placement of a subarachnoid lumbar drain. No death occurred. Conclusion Transoral technique is a viable and useful option in the treatment of irreducible ventral craniocervical junction bony compression.