Tumors or masses occurring in the cervicothoracic region show a broad variety in their histologic origin. Accordingly, the indication for surgical resection varies, and especially in malignant lesions, surgery frequently is part of a multimodality treatment. Adequate access is important for any operation in a critical region such as the cervicothoracic junction. The anatomic location of the mass to be resected usually dictates either an anterior or posterior approach. The need for appropriate exposure is in addition paralleled by the need to preserve a maximum of important functional structures, to maintain their diligent functional interaction. Careful interdisciplinary preoperative treatment planning is necessary to achieve optimal results.