Endonasal access to the upper cervical spine, part one: radiographic morphometric analysis

Area of Science:

• Neurosurgery
• Anatomy
• Medical Imaging

Background:

• Endonasal access to the upper cervical spine is a developing surgical approach.
• Understanding anatomical limitations is crucial for successful endoscopic procedures.

Purpose of the Study:

• To define anatomical relationships influencing endonasal access to the upper cervical spine.
• To correlate radiographic measurements with potential endoscopic visualization limits.

Main Methods:

• Retrospective analysis of computed tomography (CT) scans from 100 adult patients.
• Morphometric analysis of hard palate length, distance, and angle to the odontoid process.
• Simulation of endoscopic visualization using projected angles from the hard palate.

Main Results:

• An inverse relationship exists between hard palate length and visualized cervical spine zones.
• Distance and angle between the hard palate and odontoid process directly impact achievable cervical exposure.
• Hard palate length influences the lowest cervical spine level accessible via nasal endoscopy.

Conclusions:

• Radiographic parameters, including hard palate length and its relationship to the odontoid, predict endonasal access limits.
• These anatomical insights are vital for planning endoscopic approaches to the upper cervical spine.
• Findings are corroborated by cadaveric data, enhancing their clinical relevance.