Walk the Line. The Surgical Highways to the Craniovertebral Junction in Endoscopic Approaches: A Historical Perspective

Massimiliano Visocchi, Domenico Gerardo Iacopino, Francesco Signorelli, Alessandro Olivi, Rosario Maugeri

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: We compiled a comprehensive literature review on the anatomic and clinical results of endoscopic approaches to the craniocervical junction (CVJ) to better contribute to identify the best strategy. Methods: An updated literature review was performed in the PubMed, OVID, and Google Scholar medical databases, using the terms “Craniovertebral junction,” “Transoral approach,” “Transnasal approach,” “Transcervical approach,” “Endoscopic endonasal approach,” “Endoscopic transoral approach,” “Endoscopic transcervical approach.” Clinical series, anatomic studies, and comparative studies were reviewed. Results: Pure endonasal and cervical endoscopic approaches still have some disadvantages, including the learning curve and the deeper surgical field. Endoscopically assisted transoral surgery with 30° endoscopes represents an emerging option to standard microsurgical techniques for transoral approaches to the anterior CVJ. This approach should be considered as complementary rather than an alternative to the traditional microsurgical transoral-transpharyngeal approach. Conclusions: The transoral approach with sparing of the soft palate still remains the gold standard compared with the pure transnasal and transcervical approaches because of the wider working channel provided by the former technique. The transnasal endoscopic approach alone appears to be superior when the CVJ lesion exceeds the upper limit of the inferior third of the clivus.

Original languageEnglish (US)
Pages (from-to)544-557
Number of pages14
JournalWorld neurosurgery
StatePublished - Feb 2018
Externally publishedYes


  • Craniovertebral junction
  • Transcervical approach
  • Transnasal approach
  • Transoral approach

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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