Comparative Cadaveric Study and Anatomic Limitations of the Nasofrontal Trephination: A Novel Endoscopic Corridor for Enhanced Exposure of The Odontoid and Occipital Condyle Regions.
Mohammad Bilal Alsavaf, Moataz D Abouammo, Jaskaran Singh Gosal, Maithrea S Narayanan, Govind S Bhuskute, Chandrima Biswas, Guilherme Mansur, Kyle K VanKoevering, Kathleen Kelly, Kyle C Wu, Ricardo L Carrau, Daniel M Prevedello
{"title":"Comparative Cadaveric Study and Anatomic Limitations of the Nasofrontal Trephination: A Novel Endoscopic Corridor for Enhanced Exposure of The Odontoid and Occipital Condyle Regions.","authors":"Mohammad Bilal Alsavaf, Moataz D Abouammo, Jaskaran Singh Gosal, Maithrea S Narayanan, Govind S Bhuskute, Chandrima Biswas, Guilherme Mansur, Kyle K VanKoevering, Kathleen Kelly, Kyle C Wu, Ricardo L Carrau, Daniel M Prevedello","doi":"10.1227/ons.0000000000001590","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>The endoscopic endonasal approach (EEA) serves as the primary minimally invasive route to the ventral craniovertebral junction (CVJ). However, anatomic constraints limit its caudal reach. Multiport endoscopic approaches may complement a standard EEA providing additional reach. This anatomic study evaluates the EEA's anatomic limitations in accessing the CVJ and examines how contralateral nasofrontal trephination (CNT) port may overcome these constraints.</p><p><strong>Methods: </strong>Thirty-two cadaveric specimens underwent EEA and CNT dissections. Key measurements included the nasoaxial line (NAxL) angle, anteroposterior frontal sinus distance, interorbital distance, and distance of odontoid process from the hard palate line. Area of exposure and surgical freedom were quantified using a surgical navigation. A clinical case treated using the CNT approach has been included to demonstrate the technique, instrument utilization, successful healing, and absence of complications.</p><p><strong>Results: </strong>CNT significantly enhanced area of exposure of both odontoid (1720.41 vs 1086.62 mm2, P = <.001) and occipital condyle targets (613.32 vs 446.15 mm2, P = <.001), while EEA provided significant greater surgical freedom for both odontoid (1121.91 vs 1030.58 mm3, P = <.001) and occipital condyle (888.25 vs 827.74 mm3, P = <.001). Frontal sinus anteroposterior distance strongly correlated with CNT odontoid exposure (r = 0.889, P < .001) but not with the occipital condyle (r = -0.009, P = .966). CNT offered a wider angle of attack compared with EEA (49.8° vs 16.5°, P = <.001). NAxL angle inversely correlated with the distance of the odontoid process from the hard palate line level (r = -0.757, P < .001), while showing no significant correlation with EEA exposure area.</p><p><strong>Conclusion: </strong>CNT augments traditional EEA by enhancing inferior access during the management of complex CVJ pathologies. Although NAxL angle may provide guidance in determining the inferior extent of the EEA, anatomic variability and its poor correlation with exposure area limit its standalone utility in surgical planning.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Operative Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1227/ons.0000000000001590","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and objectives: The endoscopic endonasal approach (EEA) serves as the primary minimally invasive route to the ventral craniovertebral junction (CVJ). However, anatomic constraints limit its caudal reach. Multiport endoscopic approaches may complement a standard EEA providing additional reach. This anatomic study evaluates the EEA's anatomic limitations in accessing the CVJ and examines how contralateral nasofrontal trephination (CNT) port may overcome these constraints.
Methods: Thirty-two cadaveric specimens underwent EEA and CNT dissections. Key measurements included the nasoaxial line (NAxL) angle, anteroposterior frontal sinus distance, interorbital distance, and distance of odontoid process from the hard palate line. Area of exposure and surgical freedom were quantified using a surgical navigation. A clinical case treated using the CNT approach has been included to demonstrate the technique, instrument utilization, successful healing, and absence of complications.
Results: CNT significantly enhanced area of exposure of both odontoid (1720.41 vs 1086.62 mm2, P = <.001) and occipital condyle targets (613.32 vs 446.15 mm2, P = <.001), while EEA provided significant greater surgical freedom for both odontoid (1121.91 vs 1030.58 mm3, P = <.001) and occipital condyle (888.25 vs 827.74 mm3, P = <.001). Frontal sinus anteroposterior distance strongly correlated with CNT odontoid exposure (r = 0.889, P < .001) but not with the occipital condyle (r = -0.009, P = .966). CNT offered a wider angle of attack compared with EEA (49.8° vs 16.5°, P = <.001). NAxL angle inversely correlated with the distance of the odontoid process from the hard palate line level (r = -0.757, P < .001), while showing no significant correlation with EEA exposure area.
Conclusion: CNT augments traditional EEA by enhancing inferior access during the management of complex CVJ pathologies. Although NAxL angle may provide guidance in determining the inferior extent of the EEA, anatomic variability and its poor correlation with exposure area limit its standalone utility in surgical planning.
背景和目的：内镜下鼻内入路（EEA）是到达颅椎腹侧交界处（CVJ）的主要微创途径。然而，解剖学上的限制限制了它的尾侧伸展。多端口内镜入路可以补充标准EEA，提供额外的到达。本解剖研究评估了EEA进入CVJ的解剖局限性，并研究了对侧鼻额穿刺（CNT）端口如何克服这些限制。方法：对32例尸体标本进行EEA和CNT解剖。主要测量指标包括鼻轴角、额窦前后距离、眶间距离、齿状突到硬腭线的距离。使用手术导航对暴露面积和手术自由度进行量化。一个使用碳纳米管入路治疗的临床病例已经被包括在内，以证明该技术，仪器的使用，成功的愈合和无并发症。结果：CNT显著增加了齿状突暴露面积（1720.41 vs 1086.62 mm2）， P =结论：在复杂CVJ病变的治疗中，CNT通过增强下通路来增强传统的EEA。虽然NAxL角度可以为确定EEA的下位范围提供指导，但解剖变异性及其与暴露面积的差相关性限制了其在手术计划中的独立应用。
期刊介绍：
Operative Neurosurgery is a bi-monthly, unique publication focusing exclusively on surgical technique and devices, providing practical, skill-enhancing guidance to its readers. Complementing the clinical and research studies published in Neurosurgery, Operative Neurosurgery brings the reader technical material that highlights operative procedures, anatomy, instrumentation, devices, and technology. Operative Neurosurgery is the practical resource for cutting-edge material that brings the surgeon the most up to date literature on operative practice and technique
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
