The transoral approach is the most direct surgical approach to the pathology ventral to the brainstem and superior spinal cord. The authors analyzed eleven cases of transoral approach performed in Department of Otolaryngology in collaboration with Department of Neurosurgery in Seoul National University Hospital during the period from November, 1990 to April, 1993. Operations were carried out for congenital and traumatic lesions of the upper cervical spine in 5 cases, skull base tumor in 3 cases, and inflammation of the skull base and the spine in 3 cases. In most cases, preoperative symptoms were improved postoperatively but postoperative mortality was occurred in a 1 case. Severe postoperative complications were developed in 4 cases, which included 2 cases of meningitis and 2 cases of wound dehiscence. Some patients experienced transient swallowing difficulty, trismus and articulation change, and these symptoms were improved soon or later postoperatively.