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Clinical Neuroscience News, June 2013

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Clinical Neuroscience News, June 2013

Dr. Raj K. Narayan

Dear Readers,
Craniocervical junction (CVJ) abnormalities are relatively rare abnormalities within the complex of bony structures consisting of the occipital bone, foramen magnum and/or the first two cervical vertebrae, namely the atlas (C1) and the axis (C2). The anomalies, which vary considerably from patient to patient and may be congenital or acquired later in life through disease or injury, result in reduced support for the head and decreased space in which the lower brainstem and spinal cord can carry out their many critical functions. The result of these CVJ abnormalities is a range of debilitating symptoms from neck pain to significant, even life-threatening, sensory disturbances and paralysis of the extremities.

In the past, there was little understanding of the causes of CVJ abnormalities or adequate recognition of the contributing role they play in a host of complex conditions, including Chiari malformations. However, as you will read in this issue of Clinical Neuroscience News, work at the Cushing Neuroscience Institute has led to a number of significant breakthroughs in understanding the pathology and management of CVJ abnormalities. We know, for example, that certain congenital conditions such as Down syndrome and Ehlers-Danlos have a high incidence of CVJ instability. We also know through the accumulation of a very large database of cases that physical events including motor vehicle injuries accompanied by indirect high-energy trauma to the head and upper cervical spine can often lead to fractures at the craniocervical junction, especially of the extremely fragile atlas; and that ligamentous instability at the CVJ can result from traumatic rupture.

As you further read, you will learn in greater detail how our team’s immersion in solving complex anatomical and surgical problems related to CVJ have made it possible to decompress and stabilize these varied abnormalities, restoring patients to a good quality of life. A remarkable case study appears on page 3, and for additional case studies visit or link with the QR code below.

For more information, or to discuss a patient referral, call our hotline at (516) 562-3822 or email us at

Raj K. Narayan, MD, FACS
Chair, Department of Neurosurgery
North Shore University Hospital
and Long Island Jewish Medical Center

Director, Cushing Neuroscience Institute

Chair and Professor, Neurosurgery
Hofstra North Shore-LIJ School of Medicine


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