Figures 1 and 2. Sagittal and Coronal CT reconstructions demonstrating basilar invagination. These demonstrated basilar invagination of the odontoid process above the foramen magnum. Sagittal MRI demonstrating brainstem compression. This 35 year old man presents with a progressive history of speech and swallowing difficulties.
Physical examination is remarkable for lower cranial nerve findings.
Imaging studies demonstrate an odontoid process above the foramen magnum causing compression of the cervicomedullary junction. Because of the debilitating progression of his symptoms and the significant compression of the brainstem, it was decided for the patient to undergo a transoral decompression followed by stablization of C1-2 and fusion. 2.Transoral, transpharyngeal approach with removal of the odontoid process and decompression of the cervico-medullary junction 3. Occipito-cervical instrumentation and fusion with iliac crest bone graft. The patient was brought to the operating room and placed in a supine position.