The surgical management of tumors involving the ventral skull base presents a profound challenge, traditionally requiring extensive external or transfacial approaches that carry significant cosmetic and functional sequelae. The pursuit of minimally invasive corridors has led to the development and refinement of endoscopic endonasal techniques. The transoral route, leveraging the natural orifice of the mouth, represents another critical avenue for accessing the central skull base, particularly for pathologies situated at the craniocervical junction or lower clivus.

Thisreview details the accumulated experience and surgical protocol of the authors in performing fully endoscopic transoral surgery. It describes the specialized instrumentation, precise anatomical landmarks, and a multidisciplinary workflow involving otolaryngology and neurosurgery for the safe removal of benign and select malignant lesions. Key advantages emphasized include the direct midline trajectory without neurovascular manipulation, excellent visualization provided by modern endoscopes, and the avoidance of external incisions, which may lead to reduced postoperative pain, shorter hospital stays, and improved cosmetic outcomes.

While this approach marks an important advancement, its application is necessarily selective, limited by tumor size, lateral extension, and involvement of critical vessels. The procedure demands a high degree of surgical expertise and specialized equipment to manage potential complications such as cerebrospinal fluid leakage, pharyngeal wound healing issues, and velopharyngeal insufficiency. Continued technological innovation in instrumentation and reconstruction techniques is essential to broaden its indications.
DOI：10.15302/ENTD.2025.090006