Clinical results of the transoral operation for lesions of the craniovertebral junction and its abnormalities.

BACKGROUND: We treated 20 cases of craniovertebral junction lesions via a transoral approach. Developmental abnormalities of the craniovertebral junction accounted for 15 cases; there were 3 cases of tumor, 1 case of osteomyelitis, and 1 case of rheumatoid arthritis.
METHODS: The transoral transpharyngeal approach was used in all cases. In 17 non-tumoral patients the anterior margin of the atlas and the odontoid process were resected. In one patient with a ventral clivus chordoma, both a transoral and a transnasal transsphenoidal approach was used for partial resection of the tumor mass. In two cases the median transpharyngeal approach was combined with a jaw-facial incision. In one case a metastatic adenocarcinoma, and in another a neurinoma of the accessory nerve straddling the posterior fossa and the pharyngeal region were removed.
RESULTS: After operation four cases developed craniovertebral joint instability and required posterior cervical fusion or external fixation with a halo brace. Follow-up ranged from 2 to 44 months. In most patients neurologic function slowly improved. One worsened, and one died of respiratory failure after operation. Two patients with malignant tumors died during the follow-up period.
CONCLUSION: In patients with developmental malformations, transoral decompression will result in some neurologic improvement and arrest the progress of symptoms. Patients with tumors are likely to show a good neurologic outcome when transoral surgery is performed in the early stage of the condition.