Craniovertebral junction anomaly with kissing carotids

BACKGROUND: “Kissing carotids” typically involves the lower C4-C6 retropharyngeal space. Here, we describe a case of “kissing carotids” observed at the C1-C2 level in conjunction with basilar invagination (BI). CASE DESCRIPTION: A 34-year-old-male presented with congenital atlantoaxial dislocation and BI. The initial surgical plan was for a transoral decompression (TOD). However, this approach was abandoned when the preoperative computed tomography angiography (CTA) documented “kissing carotids” lying anteriorly at the C1-C2 level. CONCLUSION: Obtaining a CTA before performing a TOD for BI is essential to prevent an intraoperative catastrophic hemorrhage due to the laceration of “kissing carotids.”