Endoscopic Endonasal Approach to the Craniocervical Junction

Anterior odontoidectomy and ventral decompression of craniocervical junction (CCJ) pathology can be achieved via three different operative corridors: transoral, transnasal, and transcervical. Traditionally, the transoral approach has been considered the gold standard for treatment of this pathology. The endoscopic endonasal approach has been introduced to minimize the morbidity associated with the transoral approach. In this chapter, we discuss indications, surgical techniques, and treatment outcomes for the endoscopic endonasal approach for ventral CCJ decompression. We also discuss technical nuances and limitations that are unique to this approach.