{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T16:00:10Z","timestamp":1773158410613,"version":"3.50.1"},"reference-count":34,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Although the endoscopic endonasal approach (EEA) has emerged as a preferred alternative to traditional transoral access for craniovertebral junction (CVJ) surgery, its limited inferior reach beyond the C1 level remains a significant challenge. This study investigates the effectiveness of using a contralateral nasofrontal trephination (CNT) or a posterior palatectomy (PP) to enhance the caudal reach to the CVJ region.<\/jats:p>\n                  <jats:p>A quantitative cadaveric study.<\/jats:p>\n                  <jats:p>Cadaver dissection laboratory.<\/jats:p>\n                  <jats:p>A total of 15 adult human cadaveric heads.<\/jats:p>\n                  <jats:p>EEA, EEA\u2009+\u2009PP, and EEA\u2009+\u2009CNT approaches to the CVJ were performed. Neuronavigation was used for objective measurements quantifying the volume of surgical freedom, surface area of deep exposure, entry point sagittal angle, and inferior reach below the odontoid process.<\/jats:p>\n                  <jats:p>EEA\u2009+\u2009CNT demonstrated superior surgical metrics across all parameters. Surface exposure was significantly greater with EEA\u2009+\u2009CNT (107.04\u2009cm2) versus EEA\u2009+\u2009PP (86.26\u2009cm2) and standard EEA (69.78\u2009cm2; p\u2009&lt;\u20090.001). The volume of surgical freedom showed similar superiority with EEA\u2009+\u2009CNT (60.21\u2009cm3), followed by EEA\u2009+\u2009PP (34.14\u2009cm3) and EEA (26.13\u2009cm3; p\u2009&lt;\u20090.001). Inferior reach below the odontoid (CNT: 6.35\u2009cm; PP: 2.17\u2009cm; EEA: 0.9\u2009cm; p\u2009&lt;\u20090.0001) and surgical trajectory angle (CNT: 50.1\u2009degrees; PP: 21.4\u2009degrees; EEA: 16.6\u2009degrees; p\u2009&lt;\u20090.0001) demonstrated significant stepwise improvements with each adjunct technique.<\/jats:p>\n                  <jats:p>Both CNT and PP techniques significantly enhance the surgical corridor of traditional EEA for CVJ access. A CNT afforded superior surgical exposure while maintaining minimal invasiveness. PP offers a viable alternative when external incisions are undesired and lesions are confined within the C2\u2013C3 level.<\/jats:p>","DOI":"10.1055\/a-2565-9342","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T22:38:42Z","timestamp":1742942322000},"page":"190-199","source":"Crossref","is-referenced-by-count":0,"title":["Novel Strategies for Expanding the Endoscopic Caudal Access to the Craniovertebral Junction: A Cadaveric Comparative Analysis of Nasofrontal Trephination and Posterior Palatectomy"],"prefix":"10.1055","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6970-1874","authenticated-orcid":false,"given":"Moataz D.","family":"Abouammo","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt"},{"name":"Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2103-6320","authenticated-orcid":false,"given":"Maithrea S.","family":"Narayanan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head\u2013Neck Surgery, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6722-2244","authenticated-orcid":false,"given":"Mohammad Bilal","family":"Alsavaf","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2196-1364","authenticated-orcid":false,"given":"Mohammed","family":"Alwabili","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5155-6736","authenticated-orcid":false,"given":"Simona","family":"Serioli","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Spedali Civili of Brescia, University of Brescia, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1868-2553","authenticated-orcid":false,"given":"Guilherme","family":"Mansur","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jimmy","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Electrical and Computer Engineering, TECHNA Institute, University Health Network, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7974-4222","authenticated-orcid":false,"given":"Chandrima","family":"Biswas","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1453-1799","authenticated-orcid":false,"given":"Noha E.","family":"Shalaby","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Tanta University, Tanta, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8450-3806","authenticated-orcid":false,"given":"Serena","family":"Capelli","sequence":"additional","affiliation":[{"name":"Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4645-6911","authenticated-orcid":false,"given":"Jaskaran S.","family":"Gosal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6465-0961","authenticated-orcid":false,"given":"Mohamed","family":"Ammo","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Department, The University of Western Ontario, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4422-5248","authenticated-orcid":false,"given":"Mona A. H.","family":"Shehata","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5921-7042","authenticated-orcid":false,"given":"Kyle K.","family":"VanKoevering","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0009-5049","authenticated-orcid":false,"given":"Kyle C.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7438-0734","authenticated-orcid":false,"given":"Francesco","family":"Doglietto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0214-2339","authenticated-orcid":false,"given":"Daniel M.","family":"Prevedello","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3867-2032","authenticated-orcid":false,"given":"Ricardo L.","family":"Carrau","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"ref1","first-page":"E213","article-title":"The expanded endonasal approach: a fully endoscopic transnasal approach and resection of the odontoid process: technical case report","volume":"57","author":"A B Kassam","year":"2005","journal-title":"Neurosurgery"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"E15","DOI":"10.3171\/2014.7.FOCUS14301","article-title":"Evolution from microscopic transoral to endoscopic endonasal odontoidectomy","volume":"37","author":"J A Ponce-G\u00f3mez","year":"2014","journal-title":"Neurosurg Focus"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1016\/j.wneu.2017.05.125","article-title":"Transoral versus transnasal approach for craniovertebral junction pathologies: never say never","volume":"110","author":"M Visocchi","year":"2018","journal-title":"World Neurosurg"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1002\/wjo2.8","article-title":"Endoscopic endonasal approach to the craniovertebral junction","volume":"8","author":"A A Halderman","year":"2022","journal-title":"World J Otorhinolaryngol Head Neck Surg"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"E15","DOI":"10.3171\/2015.1.FOCUS14831","article-title":"Endoscopic endonasal approach for craniovertebral junction pathology: a review of the literature","volume":"38","author":"S F Morales-Valero","year":"2015","journal-title":"Neurosurg Focus"},{"issue":"08","key":"ref6","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1002\/alr.21537","article-title":"Purely endoscopic endonasal surgery of the craniovertebral junction: a systematic review","volume":"5","author":"C H Fang","year":"2015","journal-title":"Int Forum Allergy 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Technical note","volume":"6","author":"J P Wolinsky","year":"2007","journal-title":"J Neurosurg Spine"},{"issue":"08","key":"ref19","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1097\/BRS.0000000000001288","article-title":"Experimental endoscopic angular domains of transnasal and transoral routes to the craniovertebral junction: light and shade","volume":"41","author":"M Visocchi","year":"2016","journal-title":"Spine"},{"issue":"12","key":"ref20","doi-asserted-by":"crossref","first-page":"2713","DOI":"10.1007\/s00586-015-3873-6","article-title":"Videoassisted anterior surgical approaches to the craniocervical junction: rationale and clinical results","volume":"24","author":"M Visocchi","year":"2015","journal-title":"Eur Spine J"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/978-3-319-62515-7_6","article-title":"Endonasal and transoral approaches to the craniovertebral junction: a quantitative anatomical study","volume":"125","author":"F Doglietto","year":"2019","journal-title":"Acta Neurochir Suppl (Wien)"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00701-024-06389-0","article-title":"Defining the caudal limits of the endoscopic endonasal approach to the craniovertebral junction: anatomic study correlating radiographic measures","volume":"167","author":"M B Alsavaf","year":"2025","journal-title":"Acta Neurochir (Wien)"},{"issue":"01","key":"ref23","first-page":"15","article-title":"Extending the inferior limit of endoscopic endonasal surgery to the cervical spine utilizing an endoscopic endonasal posterior palatectomy","volume":"76","author":"M Fiore","year":"2015","journal-title":"J Neurol Surg B Skull Base"},{"issue":"03","key":"ref24","doi-asserted-by":"crossref","first-page":"923","DOI":"10.3171\/2016.11.JNS16637","article-title":"Endoscopic endonasal resection of the odontoid process: clinical outcomes in 34 adults","volume":"128","author":"N T Zwagerman","year":"2018","journal-title":"J Neurosurg"},{"issue":"05","key":"ref25","first-page":"499","article-title":"Endoscopic endonasal approach to the craniovertebral junction lesions: a case series of 18 patients","volume":"84","author":"B Alijani","year":"2022","journal-title":"J Neurol Surg B Skull Base"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"e406","DOI":"10.1016\/j.wneu.2020.01.219","article-title":"Clinical outcomes of endoscopic endonasal odontoidectomy: a single-center experience","volume":"137","author":"E Grose","year":"2020","journal-title":"World Neurosurg"},{"key":"ref27","first-page":"S1","article-title":"Endoscopic total odontoidectomy with preservation of C1 anterior arch through the contralateral nasofrontal trephination technique: a cadaveric study with quantitative analysis","volume":"86","author":"M D Abouammo","year":"2025","journal-title":"J Neurol Surg B Skull Base"},{"key":"ref28","first-page":"S1","article-title":"Expanding horizons in skull base surgery for the lateral recess of the sphenoid sinus: contralateral nasofrontal trephination operative video","volume":"86","author":"G Mansur","year":"2025","journal-title":"J Neurol Surg B Skull Base"},{"issue":"01","key":"ref29","first-page":"348","article-title":"Beyond traditional boundaries: a skull base morphometric cadaveric study of the novel contralateral nasofrontal trephination approach to the lateral recess of the sphenoid sinus","volume":"86","author":"G Mansur","year":"2025","journal-title":"J Neurol Surg B Skull Base"},{"key":"ref30","first-page":"S1","article-title":"Contralateral medial transorbital corridor to the infrapetrous region as a complement to the endoscopic endonasal approach","volume":"86","author":"C Biswas","year":"2025","journal-title":"J Neurol Surg B Skull Base"},{"issue":"01","key":"ref31","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1227\/ons.0000000000001053","article-title":"Morphometric comparison of endoscopic endonasal transpterygoid and precaruncular contralateral medial transorbital approaches to sphenoid sinus lateral recess","volume":"27","author":"G S Bhuskute","year":"2024","journal-title":"Oper Neurosurg (Hagerstown)"},{"issue":"06","key":"ref32","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.3171\/2024.4.JNS24730","article-title":"Comparison of endoscopic multiport approaches to the petrous apex: contralateral transmaxillary versus contralateral medial transorbital corridor","volume":"141","author":"J S Gosal","year":"2024","journal-title":"J Neurosurg"},{"issue":"04","key":"ref33","doi-asserted-by":"crossref","first-page":"E10","DOI":"10.3171\/2024.1.FOCUS23863","article-title":"Endoscopic precaruncular medial transorbital and endonasal multiport approaches to the contralateral skull base: a clinicoanatomical study","volume":"56","author":"G S Bhuskute","year":"2024","journal-title":"Neurosurg 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