Craniocervical Junction: Beyond Borders

The craniovertebral junction (CVJ) has unique anatomical bone and neurovascular structures architecture. It not only separates from the subaxial cervical spine, but it also provides a special cranial flexion, extension, and axial rotation pattern. Stability is provided by a complex combination of osseous and ligamentous support which allows a large degree of motion. The perfect knowledge of CVJ anatomy and physiology allows us to better understand instrumentation procedures of the occupation, atlas and axis and the specific diseases that affect the region. So, to review the vascular, ligamentous, and bony anatomy of the region, in relation to all the possible surgical approaches to this anatomically unique segment of the cervical spine, appears to be absolutely mandatory in order to preview and to overcome possible anatomic related complications of the CVJ surgery; moreover the knowledge of the basic principles of instrumentation and of the region kinematics, since they deal with the anatomic discussion, seem to be strategic in the preoperative planning.

Historically considered as nobody land, CVJ surgery or specialty recently gained high consideration as symbol of challenging surgery as well as selective top level qualifying surgery.

Although many years have passed since the beginning of this pioneering surgery, managing lesions situated in the anterior aspect of the CVJ still remains a challenging neurosurgical problem. Many studies are available in the literature so far aiming to examine the microsurgical anatomy of both the anterior and posterior extradural and intradural aspects of the CVJ as well as the differences in all the possible surgical exposures obtained by 360° approach philosophy. In this paper the Author provides a short but quite complete at glance tour across the personal experience and publications and the more recent literature available.

This Research Topic of Frontiers in Neurology is entirely dedicated to the CVJ and its borders. Anatomy, physiology, embryology, malformations, microsurgical and endoscopic surgery as well as instrumentation and fusion procedures of the CVJ are the main topics of the issue.

Many national and international contributors have been invited to provide their experience and to highlight tip and tricks of their surgical practice according to the trends of their own School and the worldwide interest in this special topic.

To date if we check PubMed and search for Craniovertebral Junction we can find 837 papers, Craniovertebral Junction Surgery 1164 papers, Craniovertebral Junction abnormalities 597 papers, Craniovertebral junction anatomy 765, Craniovertebral junction transoral approach 197 papers, Craniovertebral junction transnasal approach 71papers, Craniovertebral junction far lateral approach 68 papers, Craniovertebral junction extreme lateral approach 30.

Obviously, such a search must be considered unreliable since it does not reflect the exact number of specific papers dealing with the topic. Nevertheless, the blooming of special Issues on CVJ among different Journals as well as Local and International Society on CVJ (i.e. Craniovertebral Junction and Spine Society) demonstrate that such a scientific topic deserves a high consideration among the neurosurgical and spine community.

On the basis of anatomy, neurophysiology and pathophysiology we will update the possible 360° fan of surgical approaches to the CVJ and possible implications in local extension to surrounding areas fulfilling at the best the indications for local affecting lesions

All the possible Authors are invited to present their personal experience, according to the most updated literature, and suggest all the possible innovations or extensions to better address both surgical indication and the more effective therapeutic strategy.