The transoral surgical approach allows access to structures from the sphenoid sinus rostrally to the fourth cervical vertebral body caudally. It is particularly useful for lesions at the anterior aspect of the craniocervical junction. Relief of the spinal cord compression in rheumatoid atlantoaxial subluxation can be achieved by this route. Removal of extradural and intradural tumours is possible using microsurgical techniques and watertight dural closure with the aid of fibrin glue.