1997 年 11 巻 2 号 p. 123-128
Surgical treatments of craniovertebral junction lesions, focused upon Atlantoaxial dislocation (AAD) and basilar impression (BI) are discussed according to our surgical indications and surgical methods. The total number of our surgical cases of atlantoaxial dislocation (AAD) and basilar impression (BI) are 96 (posterior fusion 63, transoral anterior approach 30, combinded approach 3). The surgical approach for each case was decided as follows : If AAD is reducible, posterior fusion is selected. In nonreducible AAD or BI, if the clivoaxial angle is under 120 degree, the transoral approach is selected and if the angle is over 120 degree, posterior decompression and fusion is selected. In posterior fusion, grafting bone taken from iliac crest has been used for posterior fusion, and recently titanian wire or titanian loop and other newly developed surgical instrumentation and materials are used. Except for 3 cases in which grafted bones were absorbed, recovery after surgery was satisfactory in 63 cases in which posterior fusion was used. Except for one case, neurological improvement was obtained in 30 cases using the anterior approach. In 3 cases in which transoral approaches were used. grafted bones slipped out of portion, but this did not result in neurological deterioration. The appropriate surgical approach selsected by considering the aspect of the compression to the neural tissue of the craniovertebral junction is as follows : Posterior approach when there is reducible AAD without anterior compression. Anterior approach when there is noreducible AAD with anterior compression or basilar impression.