• Massimiliano Visocchi, Alberto Di Martino, Rosario Maugeri, Ivón González Valcárcel, Vincenzo Grasso, and Gaetano Paludetti.
• Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
• Eur Spine J. 2015 Dec 1; 24 (12): 271327232713-23.

PurposeIn this narrative review, we aim to give an update on the anatomic fundamentals of endoscopic assisted surgery to the craniocervical junction (transnasal, transoral and transcervical), and to report on the available clinical results.MethodsA non-systematic review and reporting on the anatomical and clinical results of endoscopic assisted approaches to the craniocervical junction (CVJ) is performed.ResultsPure endonasal and cervical endoscopic approaches still have some disadvantages, including the learning curve and the lack of 3-dimensional perception of the surgical field. Endoscopically assisted transoral surgery with 30° endoscopes represents an emerging alternative to standard microsurgical techniques for transoral approaches to the anterior CVJ. Used in conjunction with traditional microsurgery and intraoperative fluoroscopy, it provides a safe and improved method for anterior decompression with or without a reduced need for extensive soft palate splitting, hard palate resection, or extended maxillotomy.ConclusionsTransoral (microsurgical or video-assisted) approach with sparing of the soft palate still remains the gold standard compared to the "pure" transnasal and transcervical approaches due to the wider working channel provided by the former technique. Transnasal endoscopic approach alone appears to be superior when the CVJ lesion exceeds the upper limit of the inferior third of the clivus. Combined transnasal and transoral procedures can be tailored according to the specific pathological and radiological findings.

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