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Articulations of the Vertebral Column01:28

Articulations of the Vertebral Column

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In addition to being held together by the intervertebral discs, adjacent vertebrae also articulate with each other at synovial joints formed between the superior and inferior articular processes called zygapophysial joints (facet joints). These are plane joints that provide for only limited motions between the vertebrae. The orientation of the articular processes at these joints varies in different regions of the vertebral column and serves to determine the types of motions available in each...
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The superior view of the cranium shows the frontal and paired parietal bones.
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The cranial and spinal meninges are complex protective structures surrounding the central nervous system (CNS), consisting of the brain and spinal cord. These meninges consist of the dura mater, the arachnoid mater, and the pia mater. They protect the CNS, provide structural support, and aid in circulating cerebrospinal fluid (CSF).
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Cranial Bones: Lateral View01:27

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The lateral view of the cranium is dominated by temporal, sphenoid, and ethmoid bones.
The temporal bone forms the lower lateral side of the skull. The temporal bone is subdivided into several regions. The flattened upper portion is the squamous portion of the temporal bone. Below this area and projecting anteriorly is the zygomatic process of the temporal bone, which forms the posterior portion of the zygomatic arch. Posteriorly is the mastoid portion of the temporal bone. Projecting...
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Related Experiment Video

Updated: Mar 29, 2026

Microvascular Decompression: Salient Surgical Principles and Technical Nuances
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Endoscopic Approaches to the Craniovertebral Junction.

Varun R Kshettry1, Brian D Thorp2, Michael F Shriver3

  • 1Rosa Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, 9500 Euclid Avenue, S73, Cleveland, OH 44195, USA.

Otolaryngologic Clinics of North America
|November 29, 2015
PubMed
Summary

The endoscopic endonasal approach offers a direct surgical path to anterior craniovertebral junction lesions. This minimally invasive technique preserves soft palate function, allowing immediate oral diet resumption post-surgery.

Keywords:
CraniocervicalCraniovertebralEndonasalEndoscopicForamen magnumOdontoidectomyTransclivalTransnasal

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Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Minimally Invasive Surgery

Background:

  • Anteriorly located craniovertebral junction lesions pose surgical challenges.
  • Traditional approaches may involve significant morbidity.
  • The endoscopic endonasal approach (EEA) offers a direct corridor.

Purpose of the Study:

  • To evaluate the efficacy and benefits of the endoscopic endonasal approach for craniovertebral junction lesions.
  • To highlight the surgical planning and technical considerations for EEA in this region.

Main Methods:

  • Utilized the endoscopic endonasal approach for surgical access.
  • Defined surgical limits using anatomical landmarks (nasopalatine line, lower cranial nerves).
  • Employed a 2-surgeon, 4-handed technique combining otolaryngology and neurosurgery expertise.

Main Results:

  • Achieved direct surgical access to anterior craniovertebral junction lesions.
  • Preserved soft palate function, enabling early oral diet initiation.
  • Demonstrated the feasibility of EEA for odontoidectomy and related conditions.

Conclusions:

  • The endoscopic endonasal approach is a viable and effective method for treating anterior craniovertebral junction pathologies.
  • Careful preoperative planning and specialized surgical expertise are crucial for successful outcomes.
  • EEA offers advantages in terms of patient recovery and functional preservation.