• Pantelis Stavrinou, Evangelos Drosos, Spyridon Komaitis, Georgios P Skandalakis, Nektarios K Mazarakis, Aristotelis V Kalyvas, Theodore Troupis, Roland Goldbrunner, George Stranjalis, and Christos Koutsarnakis.
• Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany; Metropolitan Hospital, Athens, Greece.
• World Neurosurg. 2022 Oct 1; 166: e841e849e841-e849.

ObjectiveThe anterior petrosectomy, also known as the Kawase approach, and the retrosigmoid intradural suprameatal approach (RISA) have both been used to reduce the petrous apex and access the petroclival region. Our goal was to compare the volumes and 3-dimensional shapes of bony resection obtained through each approach while trying to resemble realistic surgical settings.MethodsFive cadaveric specimens totaling 10 sides were dissected and analyzed. In every specimen, 1 side was used for the Kawase approach while the opposite side was used for the RISA. Petrosectomy volumes were assessed by comparing preoperative and postoperative thin-sliced computed tomography scans.ResultsPetrosectomy volumes were significantly larger through the Kawase approach than through the RISA (0.82 ± 0.11 vs. 0.49 ± 0.07 cm3, P < 0.001). In addition, surgical maneuverability and freedom were greater in the Kawase operative variant. Lastly, the morphology of the bony window achieved through each approach was clearly different: trapezoid for the anterior petrosectomy versus elongated ellipsoid for the RISA.ConclusionsThe Kawase approach invariably results in larger volumes of bony removal than the RISA operative variant, and the volume of petrosectomy that is spatially congruent is only partially identical. The Kawase corridor is best suited for middle fossa lesions that extend into the posterior fossa, while the RISA is suitable for pathologies mainly residing in the posterior fossa and extending into the Meckel cave.Copyright © 2022 Elsevier Inc. All rights reserved.

21 keywords...

hide…