• Alexey Nikolaevich Shkarubo, Vladimir Nikolaevich Nikolenko, Ilia Valerievich Chernov, Dmitry Nikolaevich Andreev, Mikhail Alekseevich Shkarubo, Kirill Gennadievich Chmutin, and Mikhail Yegorovich Sinelnikov.
• Department of Neurosurgery, N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation; Department of Neurosurgery, RUDN University, Moscow, Russian Federation; Department of Neurosurgery, N.N. Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russian Federation. Electronic address: ashkarubo@nsi.ru.
• World Neurosurg. 2020 Jan 1; 133: e293-e302.

ObjectiveInterest in endoscopic transnasal access has increased with continued technological advances in endoscopic technology. The goals of this study were to review the normal anatomy in transnasal endoscopic neurosurgery and outline the anatomical basis for an expanded surgical approach. Defining anatomical aspects of surgical endoscopy helps guide the surgeon by defining normal anatomy of the access vector.MethodsThis anatomic study was conducted on 15 adult male cadaver specimens using various microsurgical tools and endoscopic instruments and 1 intraoperative case. The vasculature was injected with colored silicone to aid visualization. Different transnasal approach techniques were used, with angles of endoscope access at 0°, 30°, 45°, and 70° accordingly for extensive anatomical mapping.ResultsThe proximity of critical structures is different in each approach degree. A full understanding of the possible structures to be met during transnasal access is described. As a result of the study, anatomical aspects and important structures were outlined, and a surgical protocol was defined for minimal risk access in respect to normal anatomy of the area.ConclusionsThorough knowledge of topographic anatomy of the craniovertebral junction is required for performing minimal-risk surgical intervention in this region. It is important to know all anatomical aspects of the transnasal approach in order to reduce the risk of damage to vital structures. Transnasal endoscopic surgery of the craniovertebral junction is a relatively new direction in neurosurgery; therefore, anatomical studies such as the one described in this article are extremely important for the development of this access method.Copyright © 2019 Elsevier Inc. All rights reserved.

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