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Over a 15-year period, 15 patients with craniospinal malformations were operated on using the transoral route. Ten patients had basilar impression and five had atlantoaxial dislocation; nine patients had associated lesions. Patients treated with reposition and dorsal fusion recovered well without ventral decompression. We found that transoral odontoidectomy is suitable as a primary decompressing measure only in ventral compression or nondislocated atlantoaxial conditions.