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Access to the craniovertebral junction has traditionally been obtained by utilizing transoral approaches; however, the nasal corridor is a useful alternative for direct access to the craniovertebral junction with decreased morbidity. The inferior extent of the endonasal approach is limited by the palate and nasal bones and when this is reached, the caudal extent can be expanded with the combined endonasal-transoral approach. The addition of the transoral corridor allows more caudal access and allows for more complex reconstructions. In this chapter, we discuss a step-wise approach to planning for surgical access of the craniovertebral junction.
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