title: Sublabial approach for the treatment of symptomatic basilar impression in a patient with Klippel-Feil syndrome.
abstract: BACKGROUND
  Basilar impression (BI) is an uncommon condition in which there is upward displacement of the elements forming the foramen magnum, causing translocation of vertebral elements into the brainstem. Most commonly a developmental anomaly, BI is often associated with congenital conditions such as Down syndrome. Symptomatic BI is often difficult to treat surgically secondary to the anatomic variants associated with many of the coinciding congenital syndromes.
  
  
  OBJECTIVE
  To present a feasible approach for the treatment of BI.
  
  
  METHODS
  We present an alternative surgical approach for the treatment of symptomatic BI in a 37-year-old woman with Klippel-Feil syndrome. Because of the altered anatomy, traditional approaches such as the transoral-transpharyngeal, transmandibular circumglossal, and transcervical endoscopic routes were not feasible.
  
  
  RESULTS
  We chose a staged sublabial, transnasal, transpalatal route for the anterior brainstem decompression followed by posterior fixation. The patient tolerated the procedures well and at last follow-up had nearly complete resolution of symptoms.
  
  
  CONCLUSIONS
  The sublabial route is an alternative approach for anterior decompression in patients with symptomatic basilar impression and altered anatomic circumstances such as that caused by Klippel-Feil syndrome.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. cbetteg1@jhmi.edu
authors.forename: Chetan
authors.initials: C
authors.lastname: Bettegowda
authors.forename: Mehdi
authors.initials: M
authors.lastname: Shajari
authors.forename: Ian
authors.initials: I
authors.lastname: Suk
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Simmons
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
mesh_terms: D000328:Adult; D001933:Brain Stem / Q000002:abnormalities; D005260:Female; D006801:Humans; D007714:Klippel-Feil Syndrome / Q000150:complications / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010985:Platybasia / Q000601:surgery*