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The endoscopic endonasal corridor for odontoidectomy (EEO) is a valuable route in expert's hand to manage craniovertebral junction (CVJ) pathologies of the midline. The possibility to preserve part of the C1 anterior arch along to an adequate preoperative planning, makes this option a viable choice especially in elderly patients with multiple comorbidities who cannot sustain a second procedure closed in time. Indeed, the current case shows the results of EEO in the presence of ventral compression due to degenerative non-rheumatoid retro -odontoid pannus in an 80-year-old male. Due to the absence of instability preoperatively and the C1 anterior arch preservation, no posterior instrumentation was planned nor was necessary at follow-up. A step-by-step description of the technique is showed. [ABSTRACT FROM AUTHOR]