Objective: To asses the outcome of transoral microsurgical excision of anterior placed craniovertebral junction (CVJ) lesions excision followed by posterior craniocervical stabilization. Study Design: Qausi Experimental study. Setting: Department of neurosurgery PINS/Lahore General Hospital, Lahore. from May 2017 to Aug 2018. Inclusion Criteria: Male and Female patients of 12-65 yrs of age with compressive lesion at the ventral aspect of craniovertabral junction. Exclusion Criteria: Lateral and posterolateral lesions, lesion below C2 vertebral body, patient unfit for anaesthesia and surgery. Material and Methods: 12 consecutive patients coming in OPD and emergency department of our unit and fulfilling the inclusion criteria were studied. All patients were prepared for the surgery and written informed consent taken from all our patients. The patients underwent anterior trans oral microsurgical excision of the tumour followed by posterior fixation. Results: Out of 12 patients (range 12–65 years); Rheumatoid arthritis in 1 patient, tumor in 5 patients or trauma in 4 case and basilar invaginations in 2 patients. All my patients had headache (cranial and/or high-cervical pain), 73% of patients presented with quadriparesis, and 29% presented with basal cranial nerves involvements. Anterior decompression followed by posterior craniocervical fixations was done in all patients in same sitting. Out of 5 patients having severe neurological deficits preoperatively 3 improved. The remaining 7 patients have mild to moderate neurological deficits improved gradually throughout the follow-up periods to independent level. Among complications mortality in 1 patient and morbidity in the form of dural tear, CSF leak and infection in 2 patient). Craniocervical instability was seen in one patients after 3 months of surgery. Conclusion: A good surgery with proper decompression at the craniovertebral junction is technically difficult procedure and demands expertise. It needs proper preoperative planning and investigations and adequate decompression and stabilization with proper implants
