Direct and oblique approaches to the craniovertebral junction: Nuances of microsurgical and endoscope-assisted techniques along with a review of the literature

Purpose: The aim of this review is to provide an update of the technical nuances of microsurgical and endoscopic-assisted approaches to the craniovertebral junction (transnasal, transoral, and transcervical), and to report on the available clinical results in order to identify the best strategy. Methods: A nonsystematic update of the reviews and reporting on the anatomical and clinical results of endoscopic-assisted and microsurgical approaches to the craniovertebral junction (CVJ) was performed. Results: Pure endonasal and cervical endoscopic approaches still have some disadvantages, including their steep learning curves and their deeper surgical fields. Endoscopically assisted transoral s…