Abstract
Purpose
The transpetrosal–transtentorial approach provides a practical and safe surgical corridor for the treatment of petroclival region lesions. Any inaccuracies while performing this surgical technique can result in catastrophic results; nevertheless, this can be prevented under the guidance of a detailed anatomical orientation. An “intertriangles line” was defined to preserve the internal auditory canal (IAC) and cochlea during extradural bone drilling.
Methods
The anatomical study consisted of two groups: the cadaveric head and the skull group. A literature-based landmark and criteria list was created to examine the borders of the Kawase triangle/space and evaluate the anatomical structures that may be at risk during drilling for anterior petrosectomy.
Results
A total of 20 cadaveric head sides and 30 dried skull sides were examined. The rhomboid area was divided into two triangles with a common the intertriangles line. In all dissections, the IAC was found to be localized posterior to the “intertriangle line”. A minimum distance of 1 mm for the Internal Carotid artery and 2 mm for the IAC can serve as threshold values to be considered by the surgeon during drilling for petrosectomy.
Conclusions
Kawase’s area resembles a minefield, in which every step and manipulation should be considered. A minimal but effective resection of the cranial base is needed to increase safety and decrease morbidity during skull base surgery. Furthermore, this study investigated accessible and prominent landmarks to establish a feasible area of triangles and define the intertriangles line to guide the neurosurgeon under microscope and avoid IAC injury.
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Acknowledgements
The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. The results from such research can potentially increase our overall knowledge and improve patient care. Therefore, these donors and their families deserve our highest gratitude. The authors would like to express their appreciation to Yigit Gungor (Department of Anatomy, School of Medicine, Ankara University) for his efforts during anatomical dissection and Mrs. Nazmiye Kursun (Department of Biostatistics, School of Medicine, Ankara University) for performing the statistical analysis.
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Bayatli, E., Cömert, A. Scratching in the minefield: using intertriangles line to safely perform anterior petrosectomy. Surg Radiol Anat 45, 513–522 (2023). https://doi.org/10.1007/s00276-023-03131-w
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DOI: https://doi.org/10.1007/s00276-023-03131-w