Transoral approach to extradural lesions of the craniocervical junction

From 1992 to 1996, the transoral approach was used in the management of 29 patients with lesions located ventral to the craniovertebral junction. The pathology included chordoma, metastasis, inflammatory conditions, trauma and developmental abnormalities. The majority of the patients presented with myelopathy. Twenty three patients had basilar impression, in six associated with Chiari I malformation. Five patients had already been operated on by the posterior approach. The surgery was performed under microscopic vision and fluoroscopic control. Twenty-one patients required posterior stabilization. There was one post-operative death, and less postoperative morbidity. Although the authorʹs experience is limited, it is believed that this approach is a viable alternative in the treatment of extradural pathology of this region.