Endoscopic transnasal approach to the craniocervical junction.

Anterior access to the craniocervical junction has traditionally been through a transoral approach. With the advent of newer techniques, recent literature suggests a possible role for a transnasal endoscopic approach to the craniocervical junction. A review of the literature primarily consists of case reports and three anatomic cadaveric studies demonstrating the feasibility of an endonasal approach. In this retrospective review, we report our experience with four patients who underwent an endoscopic transnasal approach to the C1-C2 region. The surgical technique using a binasal endoscopic approach is described. The results indicate that the procedure is well tolerated with no significant deleterious sequelae. Although the use of this technique is in its early stages, the transnasal approach may offer a safe and effective alternative with minimal morbidity. Larger clinical studies are necessary to further explore the risks and benefits of this procedure.