[Individual surgical treatment of craniocervical junction malformation]

To explore the individual surgical treatment of various performance types of craniocervical junction malformation.

From January 2011 to December 2013, 112 patients with craniocervical junction malformations were treated at our department, including Chiari malformation (n = 65) (syringomyelia, n = 58 and without syringomyelia, n = 7), basilar invagination disease (n = 35) (with cerebellar tonsillar herniation malformation or occipitocervical fusion) and complex craniocervical malformation (n = 22) (atlantoaxial dislocation with occipitocervical fusion or with chiari malformation or cervical insufficiency sub-section). All of them had the symptoms of upper cervical nerve damage. For those with Chiari malformation, we evaluated atlanto-occipital joint stability preoperatively. If atlanto-occipital joint was stable, we performed small occipital bone window decompression, partial removal of cerebellar tonsils, loosening of posterior fossa, upper cervical adhesions, artificial dura appropriate sutured dural repair expanding neck pillow. For patients with basilar invagination, if nerve compression performance was in the rear, posterior decompression was performed. For those with complex craniocervical malformation with atlantoaxial dislocation, neck traction under anesthesia or traction after anterior release, then pillow neck fixation and fusion were performed.

During follow-ups, the symptoms improved significantly (n = 98, 87.51%). There were no symptomatic change (n = 10, 8.93%), postoperative neurological deterioration (n = 3, 2.67%) and death (n = 1, 0.89%).

According to specific clinical manifestations of craniocervical junction malformation patients, the best treatment is to perform individualized surgeries after thorough preoperative evaluations.