{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:55:29Z","timestamp":1790729729180,"version":"4.1.0"},"reference-count":15,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,9,28]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Basilar invagination (BI) with ventral cervicomedullary compression remains surgically challenging. Although transoral and endoscopic endonasal odontoidectomy are established approaches, some anatomical variations may favor alternative surgical corridors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A patient with BI developed progressive quadriparesis after cervical trauma. Imaging demonstrated severe ventral cervicomedullary compression from a retroverted, left-lateralized odontoid process, displacing the cervicomedullary junction contralaterally. CT angiography revealed absence of the left vertebral artery (VA) and medial deviation of the left internal carotid artery (ICA). Because the odontoid was significantly lateralized, causing contralateral displacement of the cervicomedullary junction, and was located behind the ICA, with absence of the ipsilateral VA, ventrolateral decompression was performed through a modified left dorsolateral extradural lateral inferior transcondylar (ELITE) approach. Posterior craniocervical fixation and fusion were subsequently performed. The patient experienced neurological improvement with satisfactory radiographic decompression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Careful evaluation of the direction of odontoid displacement and surrounding vascular anatomy is critical in selecting the surgical corridor. In selected patients with a significantly lateralized odontoid and off-midline ventral cervicomedullary compression, a modified dorsolateral ELITE approach may provide a safe and direct alternative to conventional midline anterior approaches. Medial ICA displacement and absence of the ipsilateral VA further facilitated the lateral surgical corridor.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26747\">https:\/\/thejns.org\/doi\/10.3171\/CASE26747<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26747","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:02:45Z","timestamp":1790121765000},"source":"Crossref","is-referenced-by-count":0,"title":["Staged dorsolateral decompression and posterior stabilization for severe ventral odontoid compression in basilar invagination: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3077-1493","authenticated-orcid":true,"given":"Navabhorn","family":"Jriyasetapong","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishnapundha","family":"Bunyaratavej","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udom","family":"Bawornvaraporn","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"J Neurosurg","first-page":"16","article-title":"The transoral approach to the superior cervical spine. A review of 53 cases of extradural cervicomedullary compression","volume":"71","author":"Hadley","year":"1989","unstructured":"Hadley MNSpetzler RFSonntag VK.The transoral approach to the superior cervical spine. A review of 53 cases of extradural cervicomedullary compression. J Neurosurg. 1989;71(1):16-23. doi:10.3171\/jns.1989.71.1.0016"},{"issue":"6","key":"bib2","series-title":"J Neurosurg","first-page":"962","article-title":"Basilar invagination: a study based on 190 surgically treated patients","volume":"88","author":"Goel","year":"1998","unstructured":"Goel ABhatjiwale MDesai K.Basilar invagination: a study based on 190 surgically treated patients. J Neurosurg. 1998;88(6):962-968. doi:10.3171\/jns.1998.88.6.0962"},{"issue":"4","key":"bib3","series-title":"J Neurosurg Spine","first-page":"444","article-title":"Basilar invagination: craniocervical instability treated with cervical traction and occipitocervical fixation. Case report","volume":"7","author":"Botelho","year":"2007","unstructured":"Botelho RVNeto EBPatriota GCDaniel JWDumont PARotta JM.Basilar invagination: craniocervical instability treated with cervical traction and occipitocervical fixation. Case report. J Neurosurg Spine. 2007;7(4):444-449. doi:10.3171\/SPI-07\/10\/444"},{"issue":"5","key":"bib4","series-title":"Neurosurgery","first-page":"1045","article-title":"Transoral odontoidectomy","volume":"56","author":"Mummaneni","year":"2005","unstructured":"Mummaneni PVHaid RW.Transoral odontoidectomy. Neurosurgery. 2005;56(5):1045-50."},{"issue":"1","key":"bib5","series-title":"Sports Med Arthrosc","first-page":"2","article-title":"Endoscopic transnasal odontoidectomy","volume":"24","author":"Yu","year":"2016","unstructured":"Yu YHu FZhang XSun C.Endoscopic transnasal odontoidectomy. Sports Med Arthrosc. 2016;24(1):2-6. doi:10.1097\/JSA.0000000000000081"},{"issue":"suppl 4","key":"bib6","series-title":"J Neurol Surg B Skull Base","first-page":"S370","article-title":"Endoscopic endonasal odontoidectomy","volume":"80","author":"Joshi","year":"2019","unstructured":"Joshi KWoodard TBorghei-Razavi HRecinos PFKshettry VR.Endoscopic endonasal odontoidectomy. J Neurol Surg B Skull Base. 2019;80(suppl 4):S370. doi:10.1055\/s-0039-1700510."},{"key":"bib7","series-title":"World Neurosurg","first-page":"e406","article-title":"Clinical outcomes of endoscopic endonasal odontoidectomy: a \u00adsingle-center experience","volume":"137","author":"Grose","year":"2020","unstructured":"Grose EMoldovan IDKilty SAgbi CLamothe AAlkherayf F.Clinical outcomes of endoscopic endonasal odontoidectomy: a \u00adsingle-center experience. World Neurosurg. 2020;137:e406-e415. doi:10.1016\/j.wneu.2020.01.219"},{"key":"bib8","series-title":"Fukushima Manual of Skull Base Dissection","first-page":"286","article-title":"Fukushima ELITE approach part 1: dorsolateral ELITE","author":"Fukushima","year":"2010","unstructured":"Fukushima T.Fukushima ELITE approach part 1: dorsolateral ELITE. In: Fukushima T, Nonaka Y, eds. Fukushima Manual of Skull Base Dissection. 3rd ed.AF NeuroVideo; 2010:286-300."},{"key":"bib9","series-title":"World Neurosurg","first-page":"154","article-title":"Vertebral artery transposition via an extreme-lateral approach for anterior foramen magnum meningioma or craniocervical junction tumors","volume":"88","author":"Park","year":"2016","unstructured":"Park HHLee KSHong CK.Vertebral artery transposition via an extreme-lateral approach for anterior foramen magnum meningioma or craniocervical junction tumors. World Neurosurg. 2016;88:154-165. doi:10.1016\/j.wneu.2015.12.073"},{"issue":"10","key":"bib10","series-title":"Acta Neurochir (Wien)","first-page":"2563","article-title":"Basilar decompression via a far lateral transcondylar approach: Technical note","volume":"164","author":"Rennert","year":"2022","unstructured":"Rennert RCStephens MLPalmer AWBasilar decompression via a far lateral transcondylar approach: Technical note. Acta Neurochir (Wien). 2022;164(10):2563-2572. doi:10.1007\/s00701-022-05312-9"},{"issue":"3","key":"bib11","series-title":"J Neurosurg","first-page":"920","article-title":"Extreme lateral transodontoid approach to the ventral craniocervical junction: cadaveric dissection and case illustrations","volume":"131","author":"Alzhrani","year":"2018","unstructured":"Alzhrani GGozal YMEli IExtreme lateral transodontoid approach to the ventral craniocervical junction: cadaveric dissection and case illustrations. J Neurosurg. 2018;131(3):920-930. doi:10.3171\/2018.4.JNS172935"},{"key":"bib12","series-title":"World Neurosurg","first-page":"e5","article-title":"Step-by-step dissection of the extreme lateral transodontoid approach to the anterior craniovertebral junction: surgical anatomy and technical nuances","volume":"182","author":"Abramov","year":"2024","unstructured":"Abramov ILabib MAAltshuler DStep-by-step dissection of the extreme lateral transodontoid approach to the anterior craniovertebral junction: surgical anatomy and technical nuances. World Neurosurg. 2024;182:e5-e15. doi:10.1016\/j.wneu.2023.10.132"},{"issue":"1","key":"bib13","series-title":"J Neurosurg","first-page":"1","article-title":"The transcondylar approach to extradural nonneoplastic lesions of the craniovertebral junction","volume":"84","author":"al-Mefty","year":"1996","unstructured":"al-Mefty OBorba LAAoki NAngtuaco EPait TG.The transcondylar approach to extradural nonneoplastic lesions of the craniovertebral junction. J Neurosurg. 1996;84(1):1-6. doi:10.3171\/jns.1996.84.1.0001"},{"issue":"5","key":"bib14","series-title":"Oper Neurosurg","first-page":"740","article-title":"The far-lateral approach and its variants: technical nuances and video illustration","volume":"29","author":"Kohli","year":"2025","unstructured":"Kohli GSong MEl Ahmadieh TYThe far-lateral approach and its variants: technical nuances and video illustration. Oper Neurosurg. 2025;29(5):740-745. doi:10.1227\/ons.0000000000001550"},{"issue":"5","key":"bib15","series-title":"Neurol Med Chir (Tokyo)","first-page":"231","article-title":"The subaxial cervical pedicle screw for cervical spine diseases: the review of technical developments and complication avoidance","volume":"60","author":"Jung","year":"2020","unstructured":"Jung YGJung SKLee BJThe subaxial cervical pedicle screw for cervical spine diseases: the review of technical developments and complication avoidance. Neurol Med Chir (Tokyo). 2020;60(5):231-243. doi:10.2176\/nmc.ra.2019-0189"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/13\/article-CASE26747.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/13\/article-CASE26747.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/13\/article-CASE26747.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:01:26Z","timestamp":1790726486000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/13\/article-CASE26747.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":15,"journal-issue":{"issue":"13"},"URL":"https:\/\/doi.org\/10.3171\/case26747","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]}}}