Background: Odontoidectomy for basilar invagination and craniovertebral junction pathology has traditionally been performed using a transoral route. However, the endoscopic endonasal approach to the anterior craniovertebral junction may offer safer and more effective access when compared to transoral approaches. Methods: This study is a retrospective chart review of all adult patients who underwent an endoscopic endonasal odontoidectomy at a single tertiary care center between January 2011 and May 2019. Results: Seventeen patients were included in the study. The median admission age was 67 years (range: 33-84 years) and 65% of the patients were female. One patient (1/17, 6%) had vertebral artery injury which was coiled with no neurological deficits, and 4 patients (4/17, 24%) had intraoperative CSF leaks with no postoperative leak. Fourteen patients (14/17, 82%) were extubated by POD 1. Three patients (3/17, 18%) developed postoperative sinus infections and required antibiotics. Eight patients (8/17, 47%) developed transient postoperative dysphagia. One patient (1/17, 6%) had postoperative epistaxis and one patient (1/17, 6%) had postoperative lower cranial nerve symptoms. The median length of hospital stay was 13 days (range: 2-44 days). Conclusions: Endoscopic endonasal odontoidectomy is a feasible and well-tolerated procedure for anterior decompression of craniovertebral junction, associated with satisfactory patient outcomes and low morbidity.