Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany; Metropolitan Hospital, Athens, Greece.
Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Manchester, United Kingdom; Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Hellenic Center for Neurosurgical Research, "Petros Kokkalis", Athens, Greece.
World Neurosurg. 2022 Oct;166:e841-e849. doi: 10.1016/j.wneu.2022.07.120. Epub 2022 Aug 7.
The 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.
Five 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.
Petrosectomy volumes were significantly larger through the Kawase approach than through the RISA (0.82 ± 0.11 vs. 0.49 ± 0.07 cm, 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.
The 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.
前岩骨切除术，也称为 Kawase 入路，和乙状窦后硬膜内内听道上入路（RISA），都被用于磨除岩骨尖并进入岩斜区。我们的目标是比较通过每种入路获得的骨切除体积和三维形状，同时尽量模拟真实的手术环境。
共解剖和分析了 5 具尸体标本的 10 侧。每个标本的一侧用于 Kawase 入路，另一侧用于 RISA。通过比较术前和术后的薄层 CT 扫描来评估岩骨切除术的体积。
Kawase 入路的岩骨切除术体积明显大于 RISA（0.82±0.11cm 比 0.49±0.07cm，P<0.001）。此外，Kawase 手术变体的手术可操作性和自由度更高。最后，通过每种入路获得的骨窗形态明显不同：Kawase 入路为梯形，而 RISA 为长椭圆形。
Kawase 入路总是比 RISA 手术变体产生更大的骨切除体积，而空间一致的岩骨切除体积只有部分相同。Kawase 通道最适合于延伸至后颅窝的中颅窝病变，而 RISA 适合主要位于后颅窝并延伸至 Meckel 腔的病变。
