A wide variety of lesions can affect the skull base and the craniocervical junction (CCJ) such as meningiomas, pituitary tumors, sellar or parasellar tumors, vestibular and trigeminal schwannomas, esthesioneuroblastomas, chordomas, chondrosarcomas and metastases [1], [2], [3], [4]. Depending on their precise location and extension along the skull base and their interaction with eloquent structures, different surgical approaches can be performed [5], [6], [7]. Skull base surgery has seen significant advancements and enhancements since its inception, pioneered by luminaries such as [8], Cushing [9] and Shloffer [10] and, more recently, by technical masters and teachers such as Al-Mefty, Heros and Spetzler. A deeper comprehension of anatomical landmarks coupled with technological innovation has facilitated the development of increasingly sophisticated surgical techniques over the past three decades [11], [12], [13], [14]. In this context, the remarkably detailed, skilled, and foundational contribution of Pr Albert Rhoton and his numerous fellows has played a pivotal role in advancing the comprehension and teaching of neurosurgical anatomy [15].

A comprehensive understanding of the anatomy of the craniocervical junction is paramount for performing neurosurgery in the skull base region. Herein, we present a review of the osteology of the occipital bone, the atlas (C1) and the axis (C2) and discuss the muscle anatomy of the posterior cervical region and its relationships with the vertebral artery. We will also discuss the trajectory of the vertebral artery and its distinct segments, along with providing an overview of jugular foramen anatomy and the lower cranial nerves (IX to XII). Finally, we will describe the primary surgical approaches to the craniocervical junction including the far lateral approach with its transcondylar and paracondylar extensions, the anterolateral approach pioneered by Bernard George and the endoscopic endonasal approach to the CCJ.