title: Transoral approach to extradural non-neoplastic lesions of the craniovertebral junction.
abstract: BACKGROUND
  The transoral approach allows for an unobstructed anterior view of the craniovertebral junction from the lower clivus to C1 and C2. It can be applied to a heterogeneous spectrum of pathological lesions involving this area including craniovertebral junction malformations, atlanto-axial synovial cysts, pseudoarthrosis following odontoid fractures, selected cases of retro-odontoid pannus, and vertical translocation in rheumatoid patients.
  
  
  METHODS
  Microsurgical strategy is dictated by the nature and site of the target lesion. Atlas preservation during transoral approach (atlas-sparing technique) minimizes postoperative instability and is suitable for the majority of extradural non-neoplastic lesions of the craniovertebral junction. The transoral trans-atlas approach allows for a wider exposure of the anterior craniovertebral junction, but at the price of a higher incidence of postoperative instability; it is usually required in patients with severe basilar invagination or irreducible vertical translocation in rheumatoid arthritis.
  
  
  CONCLUSIONS
  The transoral corridor is an effective route to approach a variety of anterior extradural lesions of the craniovertebral junction. Tailoring the approach to each specific lesion provides the needed exposure whilst limiting postoperative instability.
authors.affiliation: Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy, p.perrini@ao-pisa.toscana.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Perrini
authors.forename: Nicola
authors.initials: N
authors.lastname: Benedetto
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Lorenzo
mesh_terms: D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000601:surgery*; D001269:Atlanto-Occipital Joint / Q000601:surgery*; D001270:Cervical Atlas / Q000601:surgery*; D002574:Cervical Vertebrae / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D013122:Spinal Diseases / Q000601:surgery*