Defining the caudal limits of the endoscopic endonasal approach to the craniovertebral junction: anatomic study correlating radiographic measures

• DOI: 10.1007/s00701-024-06389-0
• Publication Date: 2025-01-07T09:07:44Z
• Authors: Mohammad Bilal Al...; Moataz D. Abouammo; Jaskaran Singh Gosal; Govind S. Bhuskute; Chandrima Biswas; Guilherme Mansur; Kyle K. VanKoevering; Kyle C. Wu; Ricardo L. Carrau; Daniel M. Prevedello
• Keywords: Cadaveric spasm; Hard palate; Soft palate; Neuroradiology

Abstract Objective The endoscopic endonasal approach (EEA), has become the preferred alternative to traditional open and transoral approaches ventral craniovertebral junction (CVJ) region. However, preoperative prediction of limitations caudal reach remains challenging. This cadaveric study aimed quantify CVJ area exposure access afforded by EEA, evaluate accuracy previously described radiographic anthropometric lines, identify lowest limit EEA corridor. Methods Endoscopic dissections were completed in 35 specimens. (AoE) caudal-most measured using a navigation system. Radiographic measurements included distance odontoid process from hard palate, length point reached palate level, angles such as nasopalatine line (NPL) angle, nasoaxial (NAxL) nostril-hard (NTL) rhinopalatine (RPL) angle. Results mean AoE was 931.22 ± 79.36 mm2. NPL, NAxL, RPL showed significant negative correlations with ( r = -0.521, p 0.001; -0.538, -0.500, 0.002, respectively), while NTL angle did not -0.241, 0.162). No correlation found between achieved via NTL, or > 0.05). Importantly, sole predictor variability -0.416, 0.013), shorter lengths associated increased exposure. level 9.47 1.24 mm. Conclusions anatomic highlights anatomy defined lines for predicting limits EEA. Hard emerged only reliable surgical Clinical studies are warranted validate these findings define potential need adjunctive routes managing complex pathologies.