SHORT REPORT Fatal instability following “odontoid sparing ” transoral decompression of a periodontoid pseudotumour

Pseudotumour of the craniovertebral junction is an uncom-mon cause of high cervical myelopathy in the elderly. The anterior transoral approach is the preferred means of accessing these lesions. An “odontoid sparing ” transoral approach, in which there is only minimal bone removal, is thought to preserve stability of the craniovertebral junction, obviating the need for posterior stabilisation. This report is of an 82 year old man who developed fatal atlanto-axial instability following an odontoid sparing transoral resec-tion of a pseudotumour. This complication has not previously been described and its occurrence has important implications for the surgical management of this condition. Anteriorly placed extradural mass lesions at the craniover-tebral junction causing high cervical myelopathy areuncommon.1 Neoplasms are the most frequently en-countered masses, although non-neoplastic lesions such a