Abstract
The Endoscopic Endonasal Far-Medial approach represents the coronal expansion of the conventional endoscopic endonasal approach to the lower third of the clivus, which allows access to the condylar region and adjacent structures such as the jugular foramen, jugular tubercle, and the craniocervical junction. The Far-Medial approach has proven to be a safe and effective surgical route to access tumors located ventral to the brainstem and medial to the lower cranial nerves and the vertebral artery; such as chondrosarcomas, chordomas, and posterior fossa meningiomas. The access to this region is particularly challenging, requiring a thorough understanding of the surgical anatomy and an experienced skull base team. In this chapter we review the indications, relevant surgical anatomy, operative nuances and drawbacks of the endoscopic endonasal approach to the inferolateral region of the clivus; providing anatomical dissections and illustrative cases. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021. All rights reserved.