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Endoscopic Endonasal Approach to Occipital Condyle: Key to "Far-Medial Approach" - A Cadaveric Study
Keyur G Shah1, Srinivas Dwarakanath1, Gyani J S Birua1
1Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India.
Neurology India
|July 24, 2025
Summary
This study details the endoscopic endonasal approach to the occipital condyle, providing anatomical measurements and technical steps. It highlights the need for specialized instruments for this minimally invasive surgical technique.
Area of Science:
- Neurosurgery
- Anatomy
- Endoscopic Surgery
Background:
- The endoscopic endonasal approach (EEA) offers a minimally invasive route to the skull base.
- The occipital condyle presents unique anatomical challenges for surgical access.
Purpose of the Study:
- To anatomically delineate structures relevant to the expanded EEA to the occipital condyles.
- To outline procedural steps for safe exposure, avoiding neurovascular injury.
Main Methods:
- Dissection of 20 human cadaver sides using a 0-degree endoscope.
- Systematic anatomical measurements and photographic/video documentation.
Main Results:
- Mean distance from nose tip to anterior occipital condyle (ToN-aOC): 10.8 cm.
- Mean distance from nose tip to anterior hypoglossal canal (ToN-aHG): 11.4 cm.
- Average intercondylar distance (aOC-aOC): 1.3 cm; interhypoglossal canal distance (aHG-aHG): 3.1 cm.
Conclusions:
- The study provides a stepwise guide for the endoscopic endonasal approach to the occipital condyle.
- This approach necessitates longer instruments than the transsphenoidal approach.
- Anterior occipital condyle drilling enhances the surgical corridor for the lower lateral clivus.
