Background: patients with ventral cervical-medullary compression require anterior decompression of the cervicomedullary junction. Odontoid resection can be accomplished through expanded endoscopic approach especially in cases of irreducible basilar invagination in which the pathology is situated well above the palatine line. Methods: We are presenting our experience at the Ottawa Hospital (TOH) over the last seven years in patients who underwent expanded endoscopic endonasal decompression of their cervicomedullary junction. 16 patients underwent such procedure, those patients with preoperative cervical instability underwent posterior fusion for stabilization at the same surgical setting. Follow up ranged from 9 months to 5 years. Results: All patients had severe symptoms of myelopathy and some lower cranial nerves dysfunction. All patients were extubated after recovery from anesthesia and allowed oral intake next day. patients demonstrated improvement in their symptoms and none of them required tracheostomy. 12.5% experienced transient velopharyngeal insufficiency. one patient had CSF leak which was successfully treated with lumbar drain and one patient developed infection from the posterior cervical fusion and required debridement. All patients were eventually discharged home. Postoperative imaging demonstrated excellent decompression of the anterior cervicomedullary junction pathology. Conclusions: The expanded endoscopic endonasal approach for odontoidectomy should be considered as a minimally invasive approach for anterior decompression in selected cases