Neurosurgery
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To provide a comprehensive review of the biomechanics, pathophysiology, and clinical management of atlas fractures. ⋯ Atlas fractures can be treated with halo-brace immobilization with acceptable outcomes. The role of surgical fixation, especially for atlas burst fractures, requires further study for clarification.
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A number of anterior approaches to the craniocervical junction have been described to allow exposure to the midline and lateral aspects of both the cranial base and upper cervical spine. The transoral-transpharyngeal approach, a technique that is well known to many spine surgeons, provides surgical access to the anterior clivus, C1, and C2. ⋯ The transoral-transpharyngeal approach remains the "gold standard" for anterior approaches to the cervical spine. Endoscopic endonasal and endoscopic transcervical approaches are promising alternatives that may become more mainstream as experience with these approaches increases.
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The indications and operative technique for a number of posterolateral approaches to the craniovertebral junction (CVJ) are reviewed. ⋯ All surgeons treating lesions of the CVJ should be familiar with the posterolateral approach and its modifications.