Acta Neurochirurgica

, Volume 156, Issue 6, pp 1231–1236 | Cite as

Transoral approach to extradural non-neoplastic lesions of the craniovertebral junction

  • Paolo PerriniEmail author
  • Nicola Benedetto
  • Nicola Di Lorenzo
How I Do it - Spine



The transoral approach allows for an unobstructed anterior view of the craniovertebral junction from the lower clivus to C1 and C2. It can be applied to a heterogeneous spectrum of pathological lesions involving this area including craniovertebral junction malformations, atlanto-axial synovial cysts, pseudoarthrosis following odontoid fractures, selected cases of retro-odontoid pannus, and vertical translocation in rheumatoid patients.


Microsurgical strategy is dictated by the nature and site of the target lesion. Atlas preservation during transoral approach (atlas-sparing technique) minimizes postoperative instability and is suitable for the majority of extradural non-neoplastic lesions of the craniovertebral junction. The transoral trans-atlas approach allows for a wider exposure of the anterior craniovertebral junction, but at the price of a higher incidence of postoperative instability; it is usually required in patients with severe basilar invagination or irreducible vertical translocation in rheumatoid arthritis.


The transoral corridor is an effective route to approach a variety of anterior extradural lesions of the craniovertebral junction. Tailoring the approach to each specific lesion provides the needed exposure whilst limiting postoperative instability.


Transoral approach Craniovertebral junction Odontoidectomy Basilar invagination 



The authors are thankful to Miss Juliet Strachan for English revision.

Conflicts of interest


Supplementary material


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Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Paolo Perrini
    • 1
    Email author
  • Nicola Benedetto
    • 1
  • Nicola Di Lorenzo
    • 2
  1. 1.Department of NeurosurgeryAzienda Ospedaliero Universitaria Pisana (AOUP)PisaItaly
  2. 2.Department of NeurosurgeryUniversity of FlorenceFirenzeItaly

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