• Joel Kaye, John Na, Katarina Stephan, Ella Bal, Ivanna Nebor, Sean Bucherl, Eric Nauman, Rani Nasser, Justin Virojanapa, Norberto Andaluz, and Jonathan A Forbes.
• Department of Neurological Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. Electronic address: kayejl@ucmail.uc.edu.
• World Neurosurg. 2024 Sep 1; 189: e959e969e959-e969.

ObjectiveTo evaluate the feasibility of a novel method for occipitocervical fixation (OCF) through the endonasal corridor.MethodsThin-cut computed tomography scans were obtained for 5 cadaveric specimens. Image segmentation was used to reconstruct 3D models of each O-C1 joint complex. Using computer-aided design software, plates were custom-designed to span each O-C1 joint, sit flush onto the bony surface, and accommodate screws. The final models were 3D-printed in titanium. For implantation, specimens were held in pin-fixation and registered to neuronavigation. A rigid 0º endoscope was used for endonasal visualization. An inverted U-shaped nasopharyngeal flap was raised to expose the occipital condyles and C1. The plates were introduced and fixed with bone screws. Computed tomography scans were obtained to assess screw accuracy and proximity to critical neurovascular structures. Screw entry points and trajectories were recorded.ResultsEndonasal OCF was performed on 5 cadaveric specimens. The mean starting point for occipital condyle screws was 6.17 mm lateral and 5.38 mm rostral to the medial O-C1 joint. Mean axial and sagittal trajectories were 7.98° and 6.71°, respectively. The mean starting point for C1 screws was 16.11 mm lateral to the C1 anterior tubercle and 6.39 mm caudal to the medial O-C1 joint. Mean axial and sagittal trajectories were 10.97° and -9.91°, respectively.ConclusionsEndonasal OCF is technically and anatomically feasible. The application of this technique may allow for same-stage endonasal decompression and fixation, offering a minimally invasive alternative to current methods of fixation and advancing surgeons' ability to treat pathology of the craniovertebral junction. Next steps will focus on biomechanical testing.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

23 keywords...

hide…