{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:09:32Z","timestamp":1789430972242,"version":"build-2803163510"},"reference-count":212,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:p>The craniovertebral junction (CVJ), or the craniocervical junction (CCJ) as it is otherwise known, houses the crossroads of the CNS and is composed of the occipital bone that surrounds the foramen magnum, the atlas vertebrae, the axis vertebrae, and their associated ligaments and musculature. The musculoskeletal organization of the CVJ is unique and complex, resulting in a wide range of congenital, developmental, and acquired pathology. The refinements of the transoral approach to the CVJ by the senior author (A.H.M.) in the late 1970s revolutionized the treatment of CVJ pathology. At the same time, a physiological approach to CVJ management was adopted at the University of Iowa Hospitals and Clinics in 1977 based on the stability and motion dynamics of the CVJ and the site of encroachment, incorporating the transoral approach for irreducible ventral CVJ pathology. Since then, approaches and techniques to treat ventral CVJ lesions have evolved. In the last 40 years at University of Iowa Hospitals and Clinics, multiple approaches to the CVJ have evolved and a better understanding of CVJ pathology has been established. In addition, new reduction strategies that have diminished the need to perform ventral decompressive approaches have been developed and implemented.<\/jats:p>\n                  <jats:p>In this era of surgical subspecialization, to properly treat complex CVJ pathology, the CVJ specialist must be trained in skull base transoral and endoscopic endonasal approaches, pediatric and adult CVJ spine surgery, and must understand and be able to treat the complex CSF dynamics present in CVJ pathology to provide the appropriate, optimal, and tailored treatment strategy for each individual patient, both child and adult. This is a comprehensive review of the history and evolution of the transoral approaches, extended transoral approaches, endoscopie assisted transoral approaches, endoscopie endonasal approaches, and CVJ reduction strategies. Incorporating these advancements, the authors update the initial algorithm for the treatment of CVJ abnormalities first published in 1980 by the senior author.<\/jats:p>","DOI":"10.3171\/2015.1.focus14837","type":"journal-article","created":{"date-parts":[[2015,4,1]],"date-time":"2015-04-01T13:05:25Z","timestamp":1427893525000},"page":"E8","source":"Crossref","is-referenced-by-count":82,"title":["Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update"],"prefix":"10.3171","volume":"38","author":[{"given":"Brian J.","family":"Dlouhy","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nader S.","family":"Dahdaleh","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold H.","family":"Menezes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"MD","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus14837","series-title":"J Neurosurg Sci","first-page":"85","article-title":"Endoscopic endonasal transsphenoidal approach to the sellar region: technical evolution of the methodology and refinement of a dedicated instrumentation","volume":"43","author":"Alfieri","year":"1999"},{"key":"b2-focus14837","series-title":"Neurosurgery","first-page":"672","article-title":"Combined transoral and median labiomandibular glossotomy approach to the upper cervical spine","volume":"8","author":"Arbit","year":"1981"},{"issue":"6 Suppl","key":"b3-focus14837","series-title":"Neurosurgery","first-page":"ons158","article-title":"Radiographic and anatomic basis of endoscopic anterior craniocervical decompression: a comparison of endonasal, transoral, and transcervical approaches","volume":"65","author":"Baird","year":"2009"},{"key":"b4-focus14837","series-title":"J Neurosurg","first-page":"301","article-title":"Anatomical analysis of transoral surgical approaches to the clivus","volume":"105","author":"Balasingam","year":"2006"},{"key":"b5-focus14837","series-title":"Childs Nerv Syst","first-page":"1795","article-title":"Endoscopic endonasal resection of the odontoid peg\u2014case report and literature review","volume":"28","author":"Beech","year":"2012"},{"key":"b6-focus14837","series-title":"Proc R Soc Med","first-page":"896","article-title":"Stabilization of the upper cervical spine by the transpharyngeal route","volume":"63","author":"Bonney","year":"1970"},{"key":"b7-focus14837","series-title":"Proc R Soc Med","first-page":"585","article-title":"Malignant destruction of the axis. 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