NDLI: Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension.

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Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension.

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Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Tripathi, Manjul Deo, Rama Chandra Suri, Ashish Srivastav, Vinkle Baby, Britty Kumar, Subodh Kalra, Prem Banerjee, Subhashis Prasad, Sanjiva Paul, Kolin Roy, Tara Sankar Lalwani, Sanjeev
Description	Author Affiliation: Tripathi M ( Departments of 1 Neurosurgery.); Deo RC ( Departments of 1 Neurosurgery.); Suri A ( Departments of 1 Neurosurgery.); Srivastav V ( Departments of 1 Neurosurgery.); Baby B ( Departments of 1 Neurosurgery.); Kumar S ( Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India.); Kalra P ( Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India.); Banerjee S ( Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India.); Prasad S ( Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India.); Paul K ( Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India.); Roy TS ( Anatomy, and.); Lalwani S ( Forensic Science and Toxicology, All India Institute of Medical Sciences)
Abstract	OBJECT: The surgical corridor to the upper third of the clivus and ventral brainstem is hindered by critical neurovascular structures, such as the cavernous sinus, petrous apex, and tentorium. The traditional Kawase approach provides a 10 × 5-mm fenestration at the petrous apex of the temporal bone between the 5th cranial nerve and internal auditory canal. Due to interindividual variability, sometimes this area proves to be insufficient as a corridor to the posterior cranial fossa. The authors describe a modification to the technique of the extradural anterior petrosectomy consisting of additional transcavernous exploration and medial mobilization of the cisternal component of the trigeminal nerve. This approach is termed the modified Dolenc-Kawase (MDK) approach. METHODS: The authors describe a volumetric analysis of temporal bones with 3D laser scanning of dry and drilled bones for respective triangles and rhomboid areas, and they compare the difference of exposure with traditional versus modified approaches on cadaver dissection. Twelve dry temporal bones were laser scanned, and mesh-based volumetric analysis was done followed by drilling of the Kawase triangle and MDK rhomboid. Five cadaveric heads were drilled on alternate sides with both approaches for evaluation of the area exposed, surgical freedom, and angle of approach. RESULTS: The MDK approach provides an approximately 1.5 times larger area and 2.0 times greater volume of bone at the anterior petrous apex compared with the Kawase's approach. Cadaver dissection objectified the technical feasibility of the MDK approach, providing nearly 1.5-2 times larger fenestration with improved view and angulation to the posterior cranial fossa. Practical application in 6 patients with different lesions proves clinical applicability of the MDK approach. CONCLUSIONS: The larger fenestration at the petrous apex achieved with the MDK approach provides greater surgical freedom at the Dorello canal, gasserian ganglion, and prepontine area and better anteroposterior angulation than the traditional Kawase approach. Additional anterior clinoidectomy and transcavernous exposure helps in dealing with basilar artery aneurysms.
File Format	HTM / HTML
ISSN	00223085
e-ISSN	19330693
Journal	Journal of Neurosurgery
Issue Number	1
Volume Number	123
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2015-07-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurosurgery Cranial Fossa, Middle Surgery Neurosurgical Procedures Petrous Bone Skull Base Neoplasms Cadaver Cranial Fossa, Posterior Imaging, Three-dimensional Temporal Bone Comparative Study Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery

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