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​Basilar Invagination

What is Basilar Invagination?

Basilar invagination is an uncommon condition that occurs when the upper portion of the second vertebra (C2) moves upward. This may cause compression of the spinal cord and brainstem, creating a variety of neurologic problems, including sudden death.

Basilar invagination may:

  • Be present at birth
  • Occur as the result of an accident
  • Occur in people with bone diseases such as rheumatoid arthritis

Patients with minor symptoms due to basilar invagination can often be treated without surgery. They may undergo physical therapy, be prescribed non-steroidal anti-inflammatory medication, or wear a cervical collar.

Those with ongoing symptoms, however, may require surgery. This usually involves the removal of the bone causing the pressure.

If you need surgery, UPMC surgeons will use the Endoscopic Endonasal Approach (EEA) to treat basilar invagination. This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable areas.

EEA benefits include:

  • No incisions to heal
  • No disfigurement to the patient
  • Faster recovery time

Diagnosing Basilar Invagination

Symptoms of basilar invagination

Those with basilar invagination may experience the following symptoms:

  • Headache
  • Dizziness
  • Confusion
  • Swallowing problems
  • Numbness/tingling in the extremities
  • Paralysis

Symptoms of basilar invagination can become worse with flexion of the head, which even further drapes the brainstem and/or spinal cord over the upper portion of the second vertebra.

Imaging and radiology tests for diagnosing basilar invagination

Doctors use imaging studies — such as head x-rays, CT, and MRI scans — to diagnose basilar invagination.

Basilar Invagination Treatments

For basilar invagination that is not compressing the spinal cord may include non-surgical treatments such as:

  • Physical therapy
  • Non-steroidal anti-inflammatory medication
  • A cervical collar

Minimally invasive surgery

UPMC neurosurgeons will use the Endoscopic Endonasal Approach (EEA) to decompress the brainstem and spinal cord.

This state-of-the-art, minimally invasive surgical procedure uses the nose as a natural corridor to reach these lesions, without any incisions in the face or head.

Most patients will subsequently need posterior cranio-cervical fusion to prevent recurrence and to stabilize the joints.


The UPMC Pituitary Center
At the UPMC Pituitary Center, our experts use a collaborative approach to treat patients.


Endoscopic Endonasal Approach (EEA)
Pituitary Tumor Removal Using the Endoscopic Endonasal Approach (EEA) at UPMC


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