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Objective To present the basic topographic and anatomic features of the clivus and adjacent structures with an objective of possible improvements and optimization of the extended endoscopic endonasal posterior (transclival) approach when removing tumors of the clivus and anterior regions of the posterior cranial fossa. Materials and Methods A craniometric study was conducted on 125 human skulls. A topographic anatomic study was conducted on 25 cadaver head specimens with arterial and venous beds stained with colored silicone, according to the method developed by us, to visualize its features and individual variability. Results The most important anatomic features of the external and internal regions of the clivus and the adjacent neural and vascular structures were analyzed. An accessible zone for the most effective transclival approach to the posterior cranial fossa is also specified. Conclusion The endoscopic endonasal transclival approach can be used to obtain access to centrally located tumors of the posterior cranial fossa. It is an alternative to transcranial approaches in the surgical treatment of tumors of the clivus. Highlights • We present our results of craniometric study on 125 human skulls. A topographic anatomical study was conducted on 25 cadaver head specimens. • The anatomical landmarks of a number of anatomical structures, necessary to perform the endoscopic endonasal posterior approach are described. • Upper, middle and lower transclival approaches provide access to the anterior surface neurovascular complexes of the posterior cranial. [ABSTRACT FROM AUTHOR]