• Umaru Barrie, Jonathan Tao, Faraaz Azam, Yves J Kenfack, Emerson Lout, Emmanuella Oduguwa, Benjamin Rail, Anant Naik, Abigail Jenkins, Parker Smith, Sean O'Leary, Sruthi Ranganathan, Claudia Reimer, Mahmoud Elguindy, James P Caruso, Kristen Hall, Al TamimiMazinMDepartment of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Salah G Aoun, and Carlos A Bagley.
• Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Umaru.Barrie@UTSouthwestern.edu.
• World Neurosurg. 2024 Sep 1; 189: 323338.e25323-338.e25.

ObjectiveBasilar impression (BI) is a rare yet debilitating abnormality of the craniovertebral junction, known to cause life-threatening medullary brainstem compression. Our study analyzes surgical approaches for BI and related outcomes.MethodsA systematic review was conducted using PubMed, Google Scholar, and Web of Science electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to critically assess primary articles examining BI.ResultsWe analyzed 87 patients from 65 articles, mostly female (55.17%) with a mean age of 46.31 ± 17.94 years, commonly presenting with motor (59.77%) and sensory deficits (55.17%). Commonly employed procedures included posterior occipitocervical fusion (24.14%), anterior decompression (20.69%), and combined anterior decompression with posterior fusion (21.84%). Patients who underwent anterior approaches were found to be older (55.38 ± 17.67 vs. 45.49 ± 18.78 years, P < 0.05) and had a longer duration from symptom onset to surgery (57.39 ± 64.33 vs. 26.02 ± 29.60 months, P < 0.05) compared to posterior approaches. Our analysis revealed a significant association between a longer duration from symptom onset to surgery and an increased likelihood of undergoing odontoidectomy and decompression (odds ratio: 1.02, 95% confidence interval: 1.00-1.03, P < 0.05). Furthermore, after adjusting for all other covariates, a history of rheumatoid arthritis and the use of a posterior approach were significantly associated with an elevated risk of postoperative complications (P < 0.05).ConclusionsThe treatment approach to complex craniovertebral junction disease should be tailored to the surgeon's experience and the nature of the compressive pathology.Copyright © 2024 Elsevier Inc. All rights reserved.

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