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Expanded endonasal endoscopic approaches provide access to the entire central skull base and craiocervical junction. The authors present a case of an 81-year-old man who presented with progressive spastic quadriparesis to the point of being wheel-chair bound. Cervical spine computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated multilevel extensive spondylitic changes with a large pannus at the C1-2 junction, severely compressing the spinal cord ( Figs. 1 and 2 ). Given the significant anterior spinal cord compression and the patient's substantial weakness, the decision was made to perform an endoscopic endonasal anterior cervical decompression and resection of the pannus followed a posterior cervical fusion. The patient recovered well following surgery with significant improvement of motor function. The preoperative assessment, the step-by-step surgical technique, and the technical nuances are demonstrated and discussed. The link to the video can be found at: https://youtu.be/HzrZO-0Vol4 .

Endoscopic Endonasal Resection of C1–C2 Pannus, a Step-by-Step Surgical and Anatomical Description: 2-Dimensional Operative Video