atticotomy

An atticotomy is a surgical procedure primarily used in the treatment of certain spinal conditions, particularly those involving the upper cervical spine. The term derives from the Latin *atticus*, meaning "upper," and the Greek suffix *-otomy*, indicating a cutting or incision. This procedure involves the removal or alteration of the atlas (the first cervical vertebra, also known as C1) to address pathological conditions such as basilar invagination, Chiari malformation, or other congenital or acquired abnormalities affecting the craniovertebral junction.

The primary goal of an atticotomy is to relieve pressure on the brainstem and spinal cord, which may result from structural deformities or malformations. The surgery is typically performed by neurosurgeons and may involve partial or complete resection of the atlas, along with adjustments to adjacent vertebrae or the occipital bone to stabilize the spine. Modern techniques often employ minimally invasive approaches to reduce surgical risks and improve recovery outcomes.

Indications for an atticotomy include severe cases of basilar impression, where the skull base impinges on the spinal cord, and certain forms of Chiari malformation where the cerebellum descends into the spinal canal. Preoperative imaging, such as MRI or CT scans, is essential for assessing the anatomy and planning the procedure. Postoperative care involves close monitoring for complications, including instability of the cervical spine or neurological deficits.

While effective in relieving symptoms for some patients, atticotomy carries risks such as infection, bleeding, or neurological deterioration. Long-term outcomes depend on the underlying condition and individual patient factors. The procedure is considered a last-resort option after conservative treatments, such as bracing or physical therapy, have failed to provide adequate relief. Advances in surgical techniques continue to improve the safety and efficacy of this complex intervention.