The posterior atlanto-occipital membrane spans from the posterior arch of the atlas to the posterior margin of the foramen magnum. It has a lateral aperture on each side that transmits the vertebral artery and C1 nerve root.
Restrains excessive flexion of the C0-C1 joint, limits posterior translation, and provides the posterior fibrous roof of the craniovertebral junction. The lateral aperture for the vertebral artery is a consistent landmark.
The lateral aperture is the reference for vertebral artery identification in posterior craniovertebral junction surgery. Compression of C1 nerve root by epidural pathology in this region produces upper cervical pain and suboccipital headache. The posterior atlanto-occipital membrane is divided in posterior craniovertebral decompression.
C1 nerve entrapment at the lateral aperture of the posterior membrane producing suboccipital neuralgia, treated by membrane release.
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