• Corecha SantosRomelRDepartment of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA., Raphael Bastianon Santiago, Bhavika Gupta, Rocco Dabecco, Brandon Kaye, Michal Obrzut, Badih Adada, Nathalia Velasquez, and Hamid Borghei-Razavi.
• Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA.
• World Neurosurg. 2023 Jul 1; 175: e151e158e151-e158.

ObjectiveTo describe and evaluate the steps required to perform a combined endoscopic endonasal/transoral transclival transodontoid approach for anterior decompression of the craniovertebral junction.MethodsThe endoscopic endonasal transclival transodontoid approach combined with endoscopic transoral decompression was performed on 4 cadaveric specimens. Evaluation of this combined technique; a review of the literature; and the nuances, advantages, and pitfalls are reported.ResultsAdequate wide anterior decompression was achieved in all specimens. This combined approach allowed the preservation of the anterior arch of C1 without injuring the eustachian tube anatomy and avoiding internal carotid artery manipulation.ConclusionsMastery of both techniques allows for a safe and comfortable surgical corridor. The transoral and transnasal approaches should not be considered as either/or techniques, but rather as a complement to each other. However, as with all new or developing techniques, there is a steep learning curve, which requires ample training in the skull base laboratory.Copyright © 2023 Elsevier Inc. All rights reserved.

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