Aim:The anterior endoscopic transcervical approach (AETCA) is a novel surgical technique developed to address the limitations and risks associated with traditional transoral and endonasal approaches for odontoid process pathologies. This study aimed to evaluate the anatomical features, limitations, and technical aspects of AETCA using a cadaveric model.Material and Methods:The study utilized nine human cadaver heads sectioned at the C6-7 level, fixed in 10% formalin for at least four weeks. A 0? endoscope and drills were employed for odontoid resection. The extent of resection was calculated volumetrically using pre- and post-procedure CT imaging. Fluoroscopy was used for orientation, and the resection was evaluated volumetrically using pre- and post-procedure CT imaging.Results:An average dens resection rate of 54% was achieved across the cadavers. Total resection was achieved in two cadavers, subtotal in two, and partial in five. Angled drills resulted in significantly higher resection rates compared to flat-end drills. No major vascular or neural injuries were observed. Extension to the posterior wall of the odontoid was achieved in 7 cadavers. The long and narrow surgical corridor and the difficulty of midline orientation posed challenges, but these were mitigated using a specially designed tubular trocar.Conclusion:AETCA provides significant advantages, including reduced postoperative infection risks, shorter hospital stays, and lower morbidity and healthcare costs. Our findings indicate that technical proficiency and improved equipment are critical for success, particularly in achieving complete odontoid resection while preserving surrounding structures. AETCA is a promising alternative for odontoidectomy, offering improved safety and efficiency. This study provides insights into the technical and anatomical considerations of the procedure, aiming to guide future clinical applications and reduce the learning curve.