SURGICAL MANAGEMENT OF CRANIOVERTEBRAL JUNCTION DISORDERS: CLINICAL, RADIOLOGICAL, AND OUTCOME ANALYSIS FROM A TERTIARY CARE CENTRE

Background: Craniovertebral junction (CVJ) disorders involve the occiput, atlas, and axis and may cause instability,cervicomedullary compression, and progressive neurological dysfunction. This study summarizes our institutionalexperience with surgically managed CVJ lesions. Materials and Methods: An ambispective descriptive case series wasconducted in the Department of Neurosurgery, ESIC Medical College and Superspeciality Hospital, Hyderabad, fromJanuary 2023 to March 2026. Twenty-four patients who underwent surgery for CVJ pathology were evaluated for clinicalfeatures, imaging findings, operative procedures, use of intraoperative neuromonitoring (IONM), complications, andpostoperative outcome. Results: Neck pain, gait difficulty, limb weakness, and spasticity were the common presentingfeatures. Major pathologies included atlantoaxial dislocation, basilar invagination with C1 assimilation, Chiari type Imalformation, odontoid and C2 fractures, and CVJ schwannoma. Surgical procedures included foramen magnumdecompression, occipitocervical fixation, C1-C2 fixation, and transoral odontoidectomy in selected cases. IONM was usedin technically demanding procedures. Twenty patients (83.3%) improved neurologically, while three (12.5%) remainedstable. One patient (4.2%) died following postoperative wound infection and an iatrogenic pneumothorax related to centralvenous catheterization. No new neurological deficit was recorded among survivors. Conclusion: Careful imaging,assessment of instability and reducibility, and individualized surgical planning are central to the management of CVJdisorders. Appropriate decompression and stabilization, supported by selective IONM, were associated with favorableoutcomes in most patients.