Clinical results of the transoral operation for lesions of the craniovertebral junction and its abnormalities

Abstract BACKGROUND We treated 20 cases of craniovertebral junction lesions via a transoral approach. Developmental abnormalities of the craniovertebral junction accounted for 15 cases; there were 3 cases of tumor, 1 case of osteomyelitis, and 1 case of rheumatoid arthritis. METHODS The transoral transpharyngeal approach was used in all cases. In 17 non-tumoral patients the anterior margin of the atlas and the odontoid process were resected. In one patient with a ventral clivus chordoma, both a transoral and a transnasal transsphenoidal approach was used for partial resection of the tumor mass. In two cases the median transpharyngeal approach was combined with a jaw-facial incision. In one case a metastatic adenocarcinoma, and in another a neurinoma of the accessory nerve straddling the posterior fossa and the pharyngeal region were removed. RESULTS After operation four cases developed craniovertebral joint instability and required posterior cervical fusion or external fixation with a halo brace. Follow-up ranged from 2 to 44 months. In most patients neurologic function slowly improved. One worsened, and one died of respiratory failure after operation. Two patients with malignant tumors died during the follow-up period. CONCLUSION In patients with developmental malformations, transoral decompression will result in some neurologic improvement and arrest the progress of symptoms. Patients with tumors are likely to show a good neurologic outcome when transoral surgery is performed in the early stage of the condition.