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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Direct comparison between the Kawase’s approach and the retrosigmoid intradural suprameatal (RISA) corridor to access the petroclival region using CT quantitative volumetric analysis – a cadaveric study

Vergleich zwischen Kawase’s und retrosigmoidaler intraduraler suprameataler Zugang (RISA) für Lesionen der petroklivalen Region mittels computertomographische quantitative volumetrische Analyse. Eine kadaverische Studie

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  • presenting/speaker Pantelis Stavrinou - Metropolitan Hospital Athens, Department of Neurosurgery, Athens, Griechenland; Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Athens, Griechenland; Evangelismos Hospital, National and Kapodistrian University of Athens, Department of Neurosurgery, Athens, Griechenland; Universitätsklinikum Köln, Zentrum für Neurochirurgie, Köln, Deutschland
  • Georgios Stranjalis - Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Athens, Griechenland; Evangelismos Hospital, National and Kapodistrian University of Athens, Department of Neurosurgery, Athens, Griechenland
  • Evangelos Drosos - Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Athens, Griechenland; Evangelismos Hospital, National and Kapodistrian University of Athens, Department of Neurosurgery, Athens, Griechenland
  • Spyros Komaitis - Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Athens, Griechenland; Evangelismos Hospital, National and Kapodistrian University of Athens, Department of Neurosurgery, Athens, Griechenland
  • Roland Goldbrunner - Universitätsklinikum Köln, Zentrum für Neurochirurgie, Köln, Deutschland
  • Christos Koutsarnakis - Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Athens, Griechenland; Evangelismos Hospital, National and Kapodistrian University of Athens, Department of Neurosurgery, Athens, Griechenland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocJ-HSNC01

doi: 10.3205/22dgnc011, urn:nbn:de:0183-22dgnc0119

Published: May 25, 2022

© 2022 Stavrinou et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

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Objective: The anterior petrosectomy, also known as Kawase’s approach and the retrosigmoid intradural suprameatal approach (RISA) have both been used to reduce the petrous apex and to 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.

Methods: Five cadaveric specimens totaling 10 sides were dissected and analyzed. In every specimen, one side was used for the Kawase’s approach while the opposite side for the RISA. Petrosectomy volumes were assessed by comparing pre- and postoperative thin-sliced computed tomography scans. We also present two illustrative cases that highlight each approach.

Results: Petrosectomy 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’s operative variant. Lastly, the morphology of the bony window achieved through each approach was clearly different: trapezoid for the anterior petrosectomy vs elongated ellipsoid for the RISA.

Conclusion: The Kawase’s 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. Kawase’s 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 extend into Meckel’s cave.