Scratching in the minefield: using intertriangles line to safely perform anterior petrosectomy


Bayatli E., Cömert A.

Surgical and Radiologic Anatomy, cilt.45, sa.5, ss.513-522, 2023 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 45 Sayı: 5
  • Basım Tarihi: 2023
  • Doi Numarası: 10.1007/s00276-023-03131-w
  • Dergi Adı: Surgical and Radiologic Anatomy
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CINAHL, EMBASE, MEDLINE
  • Sayfa Sayıları: ss.513-522
  • Anahtar Kelimeler: Auditory canal, Kawase's triangle, Middle fossa, Petrosectomy, Posterior fossa, Skull base, TRANSPETROSAL APPROACH, PETROCLIVAL MENINGIOMAS, HEARING PRESERVATION, PETROSAL APPROACH, 10 TRIANGLES, KAWASE, SURGERY, ANATOMY, MIDDLE, LANDMARK
  • Ankara Üniversitesi Adresli: Evet

Özet

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.