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J Neurol Surg B Skull Base 2014; 75(03): 171-176
DOI: 10.1055/s-0033-1359305
Original Article
Georg Thieme Verlag KG Stuttgart · New York

A Comparison between the Kawase and Extended Retrosigmoid Approaches (Retrosigmoid Transtentorial and Retrosigmoid Intradural Suprameatal Approaches) for Accessing the Petroclival Tumors. A Cadaveric Study

Mayur Sharma
1   Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, United States
,
Sudheer Ambekar
1   Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, United States
,
Bharat Guthikonda
1   Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, United States
,
Anil Nanda
1   Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, United States
› Author Affiliations
Further Information

Publication History

25 June 2013

23 September 2013

Publication Date:
12 March 2014 (online)

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Abstract

Background The aim of our study was to compare the area of exposure at the ventral brainstem and petroclival region offered by the Kawase, retrosigmoid transtentorial (RTT), and the retrosigmoid intradural suprameatal (RISA) approaches in cadaveric models.

Methods We performed 15 approaches (five each of the Kawase, RISA, and RTT approaches) on silicone-injected adult cadaver heads. Ventral brainstem and petroclival areas of exposure were measured and compared.

Results The mean ventral brainstem area exposed by the Kawase approach was 55.00 ± 24.1 mm2, significantly less than that exposed by RTT (441 ± 63.3 mm2) and RISA (311 ± 61 mm2) (p < 0.05). The area of ventral brainstem exposure was significantly more via RTT than through RISA (p = 0.01). The mean petroclival area of exposure through the Kawase approach was significantly smaller than that obtained through the RTT and RISA approaches (101.7 ± 545.01 mm2, 696 ± 57.7 mm2, and 716.7 ± 51.4 mm2, respectively).

Conclusion Retrosigmoid approaches provide a greater exposure of the brainstem and petroclival areas. The Kawase approach is ideally suited for lesions around the Meckel cave with an extension into the middle fossa. These approaches can be used in conjunction with one another to access petroclival tumors.

Keywords

Kawase - retrosigmoid - transtentorial - suprameatal - petroclival tumors.
 

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