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Bernhard Zünkeler, Robert Schelper and Arnold H. Menezes

of the craniocervical junction in all patients. Plain x-ray films and polytomograms were notable for the presence of nonspecific degenerative changes as might be expected in this elderly patient population. Occasionally small areas of calcification were seen in the location of the retroodontoid mass lesion. On axial CT images multiple small globular and occasionally linear areas of calcification were present within the mass lesions in all cases; however, erosion of the odontoid process was never seen. On T 1 -weighted MR images the lesions appeared mostly

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Gmaan Alzhrani, Yair M. Gozal, Ilyas Eli, Walavan Sivakumar, Amol Raheja, Douglas L. Brockmeyer and William T. Couldwell

contralateral side contributes to suboptimal resection. Given the complexity of the anatomical relationships between the occipital bone, atlas, axis, and surrounding ligaments and musculature of the craniocervical junction (CCJ), lesions located in the ventral aspect of the CCJ represent a surgical challenge. The surgical corridor for lesions located in the clivus and ventral aspect of the CCJ has evolved over time from ventral-based approaches (transoral, transfacial, and frontal transbasal) 6 , 25 , 28 to posterolateral-based approaches (far lateral and extreme lateral

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Kenichi Sato, Toshiki Endo, Kuniyasu Niizuma, Miki Fujimura, Takashi Inoue, Hiroaki Shimizu and Teiji Tominaga

T he craniocervical junction is a complex structure including the lower cranial and upper spinal nerves; caudal brainstem and rostral spinal cord; VA and its branches; veins and dural sinuses around the foramen magnum; and ligaments and muscles uniting the atlas, axis, and occipital bone. 29 Thus, AVFs at the craniocervical junction should belong to a category distinct from lesions in other spinal regions, given such peculiar characteristics as high-flow state, frequent hemorrhagic presentation, or association with other vascular anomalies. 1 , 10

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Hiroyuki Kinouchi, Kazuo Mizoi, Akira Takahashi, Yoshihide Nagamine, Keiji Koshu and Takashi Yoshimoto

, 32, 33, 35 Seven of these 15 cases were located at the craniocervical junction. 10, 16, 26, 30, 32 Shunts supplied by the radiculomeningeal arteries usually drain into the intradural coronal venous system. Most patients present with progressive paraparesis, pain, hypesthesia in the lower extremities, and diminished sphincter control. 2, 3, 23, 25, 27, 29, 30 Such spinal dysfunctions are probably caused by venous hypertension within the spinal cord. Previously, only four patients have presented with subarachnoid hemorrhage (SAH). All four cases of SAH were

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H. Alan Crockard and Robert Bradford

T he transoral approach to anteriorly placed lesions at the craniocervical junction has been in use for over 20 years. 4, 15 It is now becoming established as a relatively safe and effective method for dealing with a variety of extradural lesions around the clivus, 6, 16 foramen magnum, 8, 9 atlantoaxial complex, 1, 5, 11, 14 and upper cervical spine. 2, 10 The use of the transoral route to treat intradural lesions, in particular basilar aneurysms, 3, 12 has been less successful. The most serious problem with this approach is the high incidence of

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Harry M. Rogers and Shelley N. Chou

posterior arch of C-1 narrowed the spinal canal at the cervicomedullary junction. Skeletal survey showed multiple lucent cortical defects in the proximal femora and tibias and in the left iliac wing. Pneumoencephalogram was normal, as was the CSF examination. The clinical impression was that he had a dysplastic process in the bone, in and around the craniocervical junction, which was responsible for his headaches. Fig. 1. Skull x-ray film showing multiple lytic lesions in the occiput, base of the skull, and upper cervical spine. Operation On October

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Benedicto O. Colli and Ossama Al-Mefty

prognosis of patients with chordomas. The objective of this study was to analyze the follow-up results of a group of patients with chordomas and chondrosarcomas of the craniocervical junction and to determine the prognostic factors for these patients. Clinical Material and Methods Patient Population In this study the authors analyzed data obtained in 63 consecutive patients with chordomas and chondrosarcomas of the craniocervical junction treated by the same surgeon (O.A.) at three different institutions (University of Mississippi Medical Center, Loyola

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Farhad M. Limonadi and Nathan R. Selden

the CCJ decompression and duraplasty. Patients undergoing the dura-splitting procedure return home faster and have significantly lower operative and total hospital costs. A prospective randomized study should be conducted to compare these techniques in a uniform patient population. Abbreviations used in this paper CCJ = craniocervical junction ; CSF = cerebrospinal fluid ; LOS = length of stay ; MR = magnetic resonance . References 1. Arnett B : Arnold-Chiari malformation. Arch Neurol

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Arnold H. Menezes and John C. VanGilder

decompression. If instability is present following either the ventral or dorsal decompression, posterior fixation is required. All patients can be classified into one nonoperative and five operative categories for treatment purposes ( Table 1 ). This paper focuses on the 72 patients between the ages of 6 and 82 years who underwent ventral transoral-transpharyngeal decompression of the craniocervical junction ( Table 2 ). TABLE 1 Summary of surgical treatment at the craniovertebral junction (1977–1987) * TABLE 2 Pathology in 72 patients with transoral

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R. Shane Tubbs, Martin M. Mortazavi, Marios Loukas, Mohammadali M. Shoja and Aaron A. Cohen-Gadol

intracranial denticulate ligament (lig). Note the relationship between the course of the vertebral artery and its branches and the spinal accessory nerve (n) and first cervical rootlets to this ligament. a = artery. Used with permission from Clarian Health. Methods Ten fresh and 5 embalmed adult cadavers (30 sides) underwent dissection of the craniocervical junction. Nine specimens were male and 6 were female, and the age range of the individuals at the time of death was 49–101 years (mean 75 years). In the prone position, the specimens underwent removal of the