The transcervical retropharyngeal approach to the craniovertebral junction provides direct access to the lesion and avoids the potential bacterial contamination of the oral and pharyngeal cavity. It also prevents the development of persistent fistulae. Posterior stabilization should be performed directly after anterior neural decompression, while the patient remains under anesthesia, to prevent neurological deterioration before subsequent posterior fixation. This technique also is helpful for early mobilization of patients. The aim of surgical treatment should be to obtain biopsy tissue and to perform radical excision of epidural granulation tissue/abscess and infected bone using microsurgical technique. Antituberculous medication must be continued for 18 months with four drug regimens, and continuous monitoring of drug toxicity should be performed throughout the course of treatment.

Study design: A case report of purely epidural cavernous haemangioma with MRI appearance and pathological features.Objective: To present a rare case of extradural mass with di erential diagnosis. Setting: Delhi, India. Method: A 55-year-old man presented with progressive weakness and diminished sensation in both lower limbs. MRI demonstrated a pure extradural mass with no bony invasion. Histopathology of the lesion revealed a typical cavernous haemangioma. Result: The patient showed signi®cant improvement after surgery. Conclusion: Radiological presentation could be confusing in a purely epidural cavernous haemangioma. Awareness of the characteristics of the lesion will facilitate diagnosis and treatment of the lesion.