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Todd McCall, Jeroen Coppens, William Couldwell and Andrew Dailey

A paracondylar process is a bony exostosis that arises from the skull base lateral to the occipital condyle and extends inferiorly toward the transverse process of the atlas. This congenital anomaly can vary in size from a small protuberance to an elongated process articulating with an epitransverse process arising from C-1. Typically, a paracondylar process is an incidental finding described in anatomical studies. The authors report on a patient with a symptomatic paracondylar process articulating with an epitransverse process that caused occipitocervical pain. Resection of the paracondylar and epitransverse processes completely relieved the patient's pain.