[Indications and technic of transoral dens resection in craniocervical dysplasia]

Compressive lesions of the brain stem caused by ventrally or dorsally located bony malformations of the posterior skull base and the upper cervical spine show diffuse neurological signs and symptoms. They can imitate multiple sclerosis, cerebellar tumours, Ménière's disease and "Ménière-like" otological symptoms. Therefore, the otologist is involved in diagnosis and therapy of cranio-cervical dysplasia. At present dysplasia is differentiated into an anterior and posterior form of the disease. The most common lesion in the anterior form is brain stem compression by the high located dens axis. Therefore, transoral surgical removal of the dislocated odontoid process is the logical form of treatment and should be performed in patients with severe complaints. The technique used for the transoral resection of the odontoid process is described in detail. In 7 patients having the anterior type of the cranio-cervical dysplasia we performed a transoral resection of the elevated odontoid process. The results obtained were convincing with all patients. No intraoperative or postoperative complications were seen. Hearing impairment was not changed, neurological deficits and particularly vertigo improved. Follow-up examinations did not show any disturbances of head movements or remarkable dislocations of the kraniozervikal joints.