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P331: 3D NAVIGATION-GUIDED VOLUMETRIC AND ANGULAR QUANTITATIVE ANALYSIS OF NASOFRONTAL TREPHINATION, SUBLABIAL CONTRALATERAL TRANSMAXILLARY, AND SUBTARSAL CONTRALATERAL TRANSMAXILLARY APPROACHES TO THE SKULL BASE AND UPPER CERVICAL SPINE
Loong Siow Ping, MD; Moataz D Abouammo, MD, MSc; Sofia Pangallo, MD; Mohammad Bilal Alsavaf, MD; Je Beom Hong, MD; Yong-Li Wang, MD; Rodrigo D Gehrke, MD; Kyle K VanKoevering, MD; Kyle C Wu, MD; Daniel M Prevedello, MD, MBA; Ricardo L Carrau, MD, MBA; The Ohio State University, Wexner Medical Center

Background: Recent advances in endoscopic skull base surgery have enabled access to difficult to access anatomy. While the sublabial contralateral transmaxillary (SL-CTM) approach is well established, the nasofrontal trephination (NFT) and subtarsal contralateral transmaxillary (ST-CTM) approaches offer novel corridors whose spatial reach and angular capacities remain undefined.

Objective: To perform a 3D navigation-guided volumetric and angular analysis of NFT, SL-CTM, and ST-CTM approaches to quantify and compare their anatomical reach and assist surgical decision-making.

Methods: Five latex-injected cadaveric heads were dissected using each approach. Pre-dissection CT imaging and a stereotactic navigation system facilitated precise annotation of reachable anatomical landmarks. Using 3D Slicer software, fiducial points were reconstructed into three-dimensional models to measure accessible volumes and instrument angulation in coronal and sagittal planes.

Results: NFT approach achieved the highest mean accessible volume (156,643 mm³), followed by SL-CTM (134,982 mm³) and ST-CTM (111,458.5 mm³). NFT also demonstrated the greatest vertical angular reach (113.64° ± 29.45°), while SL-CTM achieved the broadest horizontal angulation (109.4° ± 13.36°). SL-CTM provided superior [KW1] lateral access to the paramedian skull base, whereas NFT extended further caudally toward the odontoid and craniovertebral junction. ST-CTM offered intermediate performance in both dimensions.

Conclusion: The NFT approach offers significant vertical access to midline caudal skull base lesions, making it a useful adjunct to endonasal routes.  SL-CTM approach provides enhanced lateral reach, ideal for petrous apex and paramedian targets. This study introduces a reproducible navigation-based volumetric modelling methodology to guide approach selection and optimize operative planning.

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