Evidence map›Paper›PMID 39775256›Full record

ArticleActa neurochirurgica2025

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

Mohammad Bilal Alsavaf, 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

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In one paragraph

Article in Acta neurochirurgica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Mohammad Bilal AlsavafDepartment of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
Moataz D AbouammoDepartment of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
Jaskaran Singh GosalDepartment of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA.
Govind S BhuskuteDepartment of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
Chandrima BiswasDepartment of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA.
Guilherme MansurDepartment of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA.
Kyle K VanKoeveringDepartment of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
Kyle C WuDepartment of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA.
Ricardo L CarrauDepartment of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
Daniel M PrevedelloDepartment of Otolaryngology-Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA. Daniel.Prevedello@osumc.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe endoscopic endonasal approach (EEA), has become the preferred alternative to traditional open and transoral approaches to the ventral craniovertebral junction (CVJ) region. However, preoperative prediction of the limitations of caudal reach remains challenging. This cadaveric study aimed to quantify the CVJ area of exposure and access afforded by the EEA, evaluate the accuracy of previously described radiographic anthropometric lines, and identify the lowest limit of the EEA corridor.

methodsEndoscopic endonasal dissections of the CVJ were completed in 35 cadaveric specimens. The area of exposure (AoE) and caudal-most reach were measured using a navigation system. Radiographic measurements included the distance of the odontoid process from the hard palate, length of the hard palate, distance of the lowest point reached from the hard palate level, and angles such as the nasopalatine line (NPL) angle, nasoaxial line (NAxL) angle, nostril-hard palate line (NTL) angle, and rhinopalatine line (RPL) angle.

resultsThe mean CVJ AoE was 931.22 ± 79.36 mm2. The NPL, NAxL, and RPL angles showed significant negative correlations with the distance of the odontoid process from the hard palate line (r = -0.521, p = 0.001; r = -0.538, p = 0.001; r = -0.500, p = 0.002, respectively), while the NTL angle did not (r = -0.241, p = 0.162). No significant correlation was found between achieved AoE via EEA and NPL, NAxL, NTL, or RPL (p > 0.05). Importantly, hard palate length was the sole predictor of CVJ AoE variability (r = -0.416, p = 0.013), with shorter lengths associated with increased exposure. The mean distance of the lowest point reached in the AoE from the hard palate level was 9.47 ± 1.24 mm.

conclusionsThis anatomic study highlights the variability in CVJ anatomy and the limitations of using previously defined radiographic anthropometric lines for predicting the caudal limits of the EEA. Hard palate length emerged as the only reliable predictor of the surgical area of exposure via the endonasal corridor. Clinical studies are warranted to validate these findings and define the potential need for adjunctive surgical routes in managing complex CVJ pathologies.

Indexed as

CadaverOdontoid ProcessAgedAtlanto-Axial JointAtlanto-Occipital JointEndoscopyFemaleHumansMaleMiddle AgedNatural Orifice Endoscopic SurgeryNosePalate, HardCaudal limitsCraniovertebral junctionEndoscopic endonasal surgeryHard palate lengthMultiport surgeryRadiographic anthropometric lines

Identifiers

PMID39775256
PMCPMC11706839

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.