Background: A paracondylar process is an abnormal bony exostosis arising from the skull base lateral to the occipital condyle and extending inferiorly toward the transverse process of the atlas. Paracondylar processes are typically identified incidentally and vary in size from a small protuberance to an elongated process.
Observations: The authors present the first pediatric case of torticollis secondary to a congenital paracondylar process successfully treated with resection of the paracondylar process and sternocleidomastoid release.
Lessons: Cadaveric dissection, three-dimensional models, intraoperative imaging guidance, and multidisciplinary collaboration were paramount to a successful surgical outcome. https://thejns.org/doi/10.3171/CASE2447.
Keywords: case report; congenital paracondylar process; pediatrics; three-dimensional modeling; torticollis.