The craniocervical or craniovertebral junction (CVJ) consists of the occipital bone surrounding the foramen magnum, the atlas vertebrae, the axis vertebrae, and their associated ligaments and muscles. Musculoskeletal organization of CVJ is unique and highly complex, therefore it can cause a wide variety of congenital, developmental and acquired pathologies. Surgical approaches to the pathologies of this region include anterior, posterior and lateral interventions. In the present review, we aim to make a detailed analysis of anterior surgical approaches to CVJ.