title: Videoassisted anterior surgical approaches to the craniocervical junction: rationale and clinical results.
abstract: OBJECTIVE
  In 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.
  
  
  METHODS
  A non-systematic review and reporting on the anatomical and clinical results of endoscopic assisted approaches to the craniocervical junction (CVJ) is performed.
  
  
  RESULTS
  Pure 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.
  
  
  CONCLUSIONS
  Transoral (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.
authors: Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
authors: Massimiliano
authors: M
authors: Visocchi
authors: Department of Orthopaedics and Trauma Surgery, University Campus Bio-medico of Rome, Rome, Italy. dimartino.cbm@gmail.com.
authors: Alberto
authors: A
authors: Di Martino
authors: Neurosurgery Clinic, Department of Experimental Medicine and Clinical Neurosciences, University of Palermo, Palermo, Italy.
authors: Rosario
authors: R
authors: Maugeri
authors: Neurosurgery Department, Sant Joan de Déu Children's University Hospital, Barcelona, Spain.
authors: Ivón
authors: I
authors: González Valcárcel
authors: Surgical Department, Neurosurgical Unit, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
authors: Vincenzo
authors: V
authors: Grasso
authors: Institute of Otorhinolaringology, Catholic University of Rome, Rome, Italy.
authors: Gaetano
authors: G
authors: Paludetti
mesh_terms: D001269:Atlanto-Occipital Joint / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005471:Fluoroscopy; D006801:Humans; D008866:Microsurgery / Q000379:methods; D009055:Mouth; D009296:Nasal Cavity; D009333:Neck / Q000000981:diagnostic imaging; D020535:Video-Assisted Surgery / Q000379:methods*
keywords: Endoscopic assisted approaches; Occipitocervical junction; Transnasal approach; Transoral approach; Video-assisted approaches