[3]: 426 At either lateral extremity,[3]: 426, 430  the membrane is pierced by the vertebral artery[3]: 426, 430, 452  and cervical spinal nerve C1.

[5] The membrane may be pierced with a needle at the midline superior to the arch of atlas[3]: 440  to access the cisterna magna.

[2]: 894 [3]: 440 In 2015, Scali et al. revisited the anatomy of the posterior atlantooccipital membrane via plastination.

Their findings revealed that the PAO membrane superiorly consisted of periosteum of the occiput, whereas inferiorly it formed part of the dura at the cerebrospinal junction, terminating at the level of the third cervical vertebra (rather than attaching to the posterior arch of the atlas).

[6] It is believed that this anatomical arrangement permits a superiorly located anchor point for epidural bridging structures and allows dural tensile forces to act in a summated synchronized manner.