Sublabial approach for the treatment of symptomatic basilar impression in a patient with Klippel-Feil syndrome

Chetan Bettegowda*, Mehdi Shajari, Ian Suk, Oliver P. Simmons, Ziya L. Gokaslan, Jean Paul Wolinsky

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


BACKGROUND: Basilar impression (BI) is an uncommon condition in which there is upward displacement of the elements forming the foramen magnum, causing translocation of vertebral elements into the brainstem. Most commonly a developmental anomaly, BI is often associated with congenital conditions such as Down syndrome. Symptomatic BI is often difficult to treat surgically secondary to the anatomic variants associated with many of the coinciding congenital syndromes. OBJECTIVE: To present a feasible approach for the treatment of BI. METHODS: We present an alternative surgical approach for the treatment of symptomatic BI in a 37-year-old woman with Klippel-Feil syndrome. Because of the altered anatomy, traditional approaches such as the transoral-transpharyngeal, transmandibular circumglossal, and transcervical endoscopic routes were not feasible. RESULTS: We chose a staged sublabial, transnasal, transpalatal route for the anterior brainstem decompression followed by posterior fixation. The patient tolerated the procedures well and at last follow-up had nearly complete resolution of symptoms. CONCLUSION: The sublabial route is an alternative approach for anterior decompression in patients with symptomatic basilar impression and altered anatomic circumstances such as that caused by Klippel-Feil syndrome.

Original languageEnglish (US)
Pages (from-to)ons77-ons82
Issue numberSUPPL. 1
StatePublished - Sep 2011


  • Basilar impression
  • Brainstem
  • Klippel-Feil
  • Sublabial

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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