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The clinical picture of the so-called subforaminal stenosis headache (Gutmann) and its surgical treatment (Roesner) have been presented. We have analyzed our findings in 119 patients and 55 operations. The clinical picture is characterized by increasing pain in the upper cervical and occipital region which in later stages may be accompanied also by other symptoms like disturbances of concentration, memory, libido, and potency, as well in some cases by symptoms similar to those of a secondary chronic myelopathy. The syndrome is caused by a subforaminal stenosis of the dural sac which regularly is compressed by the posterior atlas arch in connection with either morphological variations of the base of the skull or by static-functional deviations of the cranio-cervical region. The compression of the dural sac of the cranio-cervical region results in an impairment of its air chamber function, and additionally may disturb the connections between the intracranial and intraspinal venous plexus. By both factors the physiologically important smoothing function of the CSF space of the cranio-cervical region concerning intracranial pressure changes is disturbed. Treatment of choice is a laminectomy of the dorsal arch of the atlas and an osteoclastic dilatation of the foramen magnum but without opening of the dura. The results of this procedure are excellent.

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