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J Neurol Surg B Skull Base 2014; 75(03): 147-151
DOI: 10.1055/s-0033-1356491
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Volumetry and Analysis of Anatomical Variants of the Anterior Portion of the Petrous Apex Outlined by the Kawase Triangle Using Computed Tomography

Juliano Adams Pérez
1   Department of Neurosurgery, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
,
Gustavo Rassier Isolan
1   Department of Neurosurgery, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
,
Paulo Henrique Pires de Aguiar
1   Department of Neurosurgery, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
,
Apio Martins Antunes
1   Department of Neurosurgery, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
› Author Affiliations
Further Information

Publication History

06 January 2013

15 July 2013

Publication Date:
12 March 2014 (online)

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Abstract

Background Anterior petrosectomy has become an increasingly used approach for petroclival lesions. This study measures the volume and the anatomical variants of the anterior portion of the petrous apex outlined by the Kawase triangle using computed tomography (CT).

Methods This was a transversal retrospective study. We assessed the anterior petrous apex portion outlined by the Kawase triangle in consecutive patients > 18 years of age from CT scans of temporal bone stored in an archive system. The volumetry was performed on a workstation.

Results A total of 154 petrosal apex were analyzed in 77 patients (36 men). The average volume of the region outlined by the Kawase triangle was 1.89 ± 0.52 cm3. The volume average in men was 2.01 ± 0.58 cm3, and the average in women was 1.79 ± 0.41 cm3. Intra- and interobserver agreement were both excellent, and there was little variance. Nineteen petrous apex demonstrated anatomical variations. In 18 cases it was pneumatized, and in one case a vascular or nerve-like structure was identified, a report we did not find in the literature.

Conclusion The volumetry of the petrous apex anterior portion outlined by the Kawase triangle can be made by CT with excellent intra- and interobserver agreement and reproducibility. There are anatomical variants in this region that are relevant to surgery.

Keywords

petrous apex - volumetry - Kawase triangle - surgical approach
 

  • References

  • 1 Isolan GR, Rowe R, Al-Mefty O. Microanatomy and surgical approaches to the infratemporal fossa: an anaglyphic three-dimensional stereoscopic printing study. Skull Base 2007; 17 (5) 285-302
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 1985; 63 (6) 857-861
    CrossrefPubMedGoogle Scholar
  • 3 Antunes ACM, Isolan GR, Falcetta F. Tratamento dos tumores da base do crânio e infratentoriais. In: Chaves F, , Stefani, eds. Rotinas em neurologia e neurocirurgia. Porto Alegre, Brazil: Artmed; 2008
    Google Scholar
  • 4 Fournier HD, Mercier P, Roche PH. Surgical anatomy of the petrous apex and petroclival region. Adv Tech Stand Neurosurg 2007; 32: 91-146
    Google Scholar
  • 5 Isolan GR, Krayenbühl N, de Oliveira E, Al-Mefty O. Microsurgical anatomy of the cavernous sinus: measurements of the triangles in and around it. Skull Base 2007; 17 (6) 357-367
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Karkas A, Righini CA, Spinato L, Lefournier V, Schmerber S. Petrous apex lesions [in French]. Ann Otolaryngol Chir Cervicofac 2009; 126 (5–6) 283-293
    CrossrefPubMedGoogle Scholar
  • 7 Lyons BM. Surgical anatomy of the skull base. In: Donald PJ, , ed. Surgery of Skull Base. Philadelphia, PA: Lippincott-Raven; 1998: 15-30
    Google Scholar
  • 8 Connor SE, Leung R, Natas S. Imaging of the petrous apex: a pictorial review. Br J Radiol 2008; 81 (965) 427-435
    CrossrefPubMedGoogle Scholar
  • 9 Isaacson B, Kutz JW, Roland PS. Lesions of the petrous apex: diagnosis and management. Otolaryngol Clin North Am 2007; 40 (3) 479-519 , viii
    CrossrefPubMedGoogle Scholar
  • 10 Arìstegui M, Cokkeser Y, Saleh E , et al. Surgical anatomy of the extended middle cranial fossa approach. Skull Base Surg 1994; 4 (4) 181-188
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Erkmen K, Pravdenkova S, Al-Mefty O. Surgical management of petroclival meningiomas: factors determining the choice of approach. Neurosurg Focus 2005; 19 (2) E7
    PubMedGoogle Scholar
  • 12 Chang SW, Wu A, Gore P , et al. Quantitative comparison of Kawase's approach versus the retrosigmoid approach: implications for tumors involving both middle and posterior fossae. Neurosurgery 2009; 64 (3, Suppl): ons44-ons51 ; discussion ons51–ons52
    Google Scholar
  • 13 Day JD, Fukushima T, Giannotta SL. Microanatomical study of the extradural middle fossa approach to the petroclival and posterior cavernous sinus region: description of the rhomboid construct. Neurosurgery 1994; 34 (6) 1009-1016 ; discussion 1016
    CrossrefPubMedGoogle Scholar
  • 14 Hsu FP, Anderson GJ, Dogan A , et al. Extended middle fossa approach: quantitative analysis of petroclival exposure and surgical freedom as a function of successive temporal bone removal by using frameless stereotaxy. J Neurosurg 2004; 100 (4) 695-699
    CrossrefPubMedGoogle Scholar
  • 15 Kawase T. Technique of anterior transpetrosal approach. Oper Tech Neurosurg 1999; 2 (1) 10-17
    CrossrefPubMedGoogle Scholar
  • 16 Maina R, Ducati A, Lanzino G. The middle cranial fossa: morphometric study and surgical considerations. Skull Base 2007; 17 (6) 395-403
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Watanabe A, Nagaseki Y, Ohkubo S , et al. Anatomical variations of the ten triangles around the cavernous sinus. Clin Anat 2003; 16 (1) 9-14
    CrossrefPubMedGoogle Scholar
  • 18 Gonzalez LF, Amin-Hanjani S, Bambakidis NC, Spetzler RF. Skull base approaches to the basilar artery. Neurosurg Focus 2005; 19 (2) E3
    PubMedGoogle Scholar
  • 19 Villavicencio AT, Leveque JC, Bulsara KR, Friedman AH, Gray L. Three-dimensional computed tomographic cranial base measurements for improvement of surgical approaches to the petrous carotid artery and apex regions. Neurosurgery 2001; 49 (2) 342-352 ; discussion 352–353
    CrossrefPubMedGoogle Scholar
  • 20 Fleiss JL. Statistical Methods for Rates and Proportions. 2nd ed. New York, NY: Wiley & Sons; 1981
    Google Scholar
  • 21 Blevins NH, Heilman CB. Lesions of the petrous apex. In: Jackler RK, Brackman DE, , eds. Neurotology. 2nd ed. Philadelphia, PA: Elsevier Mosby; 2005: 1107-1124
    CrossrefGoogle Scholar
  • 22 Brackmann DE, Toh EH. Surgical management of petrous apex cholesterol granulomas. Otol Neurotol 2002; 23 (4) 529-533
    CrossrefPubMedGoogle Scholar
  • 23 Yetiser S, Kertmen M, Taser M. Abnormal petrous apex aeration. Review of 12 cases. Acta Otorhinolaryngol Belg 2002; 56 (1) 65-71
    PubMedGoogle Scholar
  • 24 Roland PS, Meyerhoff WL, Judge LO, Mickey BE. Asymmetric pneumatization of the petrous apex. Otolaryngol Head Neck Surg 1990; 103 (1) 80-88
    PubMedGoogle Scholar
  • 25 al-Mefty O, Anand VK. Zygomatic approach to skull-base lesions. J Neurosurg 1990; 73 (5) 668-673
    CrossrefPubMedGoogle Scholar
  • 26 Alexander Jr AE, Caldemeyer KS, Rigby P. Clinical and surgical application of reformatted high-resolution CT of the temporal bone. Neuroimaging Clin N Am 1998; 8 (3) 631-650
    PubMedGoogle Scholar
  • 27 Al-Mefty O, Ayoubi S, Kadri PA. The petrosal approach for the resection of retrochiasmatic craniopharyngiomas. Neurosurgery 2008; 62 (5) (Suppl. 02) ONS331-ONS335 ; discussion ONS335–ONS336
    PubMedGoogle Scholar
  • 28 Zhou L, Luo L, Xu J , et al. Craniopharyngiomas in the posterior fossa: a rare subgroup, diagnosis, management and outcomes. J Neurol Neurosurg Psychiatry 2010; 81 (8) 1150-1154
    PubMedGoogle Scholar