Chapter 166 - Craniovertebral Abnormalities and Their Neurosurgical Management

Abstract

Abnormalities of the craniovertebral junction can be classified as developmental, genetic, and acquired in origin. To effectively treat these disorders when they are symptomatic, the clinician has to have knowledge of the embryology, the functional anatomy as well as the biomechanics of the region. There are myriad of abnormal neurological findings, which may be present secondary to compression or ischemia of the neural structures. Thus, the surgical management of these disorders depends on precise identification of the underlying pathophysiologic condition as determined by appropriate radiologic studies. The management consists of nonoperative as well as operative treatment. The surgical approach includes an anterior, lateral, and posterior route to the craniovertebral junction with and without bony fusion. The authors have drawn on their experience and database of more than 7000 patients who had symptomatic craniovertebral junction abnormalities. With the advent of newer neurodiagnostic imaging, the armamentarium for treatment at this region has expanded significantly. The authors have tried to incorporate this into the manuscript with a detailed description of the techniques as well as ways to try to avoid pitfalls and treatment of potential complications. Preoperative craniocervical traction has been superseded by intraoperative traction with confirmation of alignment in using intraoperative three-dimensional computed tomography. The newer techniques of instrumented fusion have been described. The key references should provide the readership with a more detailed description of the techniques. The craniovertebral junction is an evolving field as seen from the initial description by the authors.