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DOI: 10.1055/s-0039-1692485
Conquering the Rock—A Retrospective Single-Center Experience of the Transapical Petrosal Transtentorial (Kawase) Approach: Operative Technique and Impact on Cranial Nerve Function
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Abstract
Since its description in 1985, the transapical petrosal transtentorial or Kawase approach has become a viable option of approaching lesions located in and around the apex of the petrous bone, Meckel's cave, and the anterolateral surface of the brain stem while preserving cranial nerve function. At the Brain Tumor Center, Erasmus MC, 25 patients were treated using the Kawase approach between 2004 and 2018 for various indications, including petroclival meningiomas, chondrosarcomas, pontine cavernomas, trigeminal schwannomas, and posterior circulation aneurysms. Hearing preservation was achieved in all patients; new abducens nerve and trochlear nerve palsies were present in three and six patients, respectively, of which a total of eight required ophthalmological correction. Seven patients experienced a cerebrospinal fluid fistula postoperatively, but this complication appeared self-limiting in all cases, with one patient experiencing secondary meningitis. After modifying our closure technique, the rate of fistulas dropped to zero. The observed direct postoperative mortality was 4% (one patient), although not related to the approach itself. In conclusion, the Kawase approach is a highly complex, but essential middle fossa approach, extremely robust, and able to serve a wide array of pathologies together with its extensions. It is very accurate for performing hearing preservation surgery, but not without caveats and inherent risk of complications.
Publikationsverlauf
Eingereicht: 14. Januar 2019
Angenommen: 11. Mai 2019
Artikel online veröffentlicht:
21. Juni 2019
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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References
- 1 Hakuba A, Nishimura S, Jang BJ. A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas. Surg Neurol 1988; 30 (02) 108-116
- 2 Dolenc V. Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg 1983; 58 (06) 824-831
- 3 Kanzaki J, Kawase T, Sano K, Shiobara R, Toya S. A modified extended middle cranial fossa approach for acoustic tumors. Arch Otorhinolaryngol 1977; 217 (01) 119-121
- 4 Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 1985; 63 (06) 857-861
- 5 Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery 1991; 28 (06) 869-875 , discussion 875–876
- 6 Aziz KM, Tew Jr JM, Chicoine MR, van Loveren HR. The Kawase approach to retrosellar and upper clival basilar aneurysms. Neurosurgery 1999; 44 (06) 1225-1234 , discussion 1234–1236
- 7 Shibao S, Borghei-Razavi H, Orii M, Yoshida K. Anterior transpetrosal approach combined with partial posterior petrosectomy for petroclival meningiomas with posterior extension. World Neurosurg 2015; 84 (02) 574-579
- 8 Shimamoto Y, Kawase T, Sasaki H, Shiobara R, Yamada F. Anterior transpetrosal approach to the prepontine epidermoids. Skull Base Surg 1999; 9 (02) 75-80
- 9 Shiobara R, Ohira T, Inoue Y, Kanzaki J, Kawase T. Extended middle cranial fossa approach for vestibular schwannoma: technical note and surgical results of 896 operations. Prog Neurol Surg 2008; 21: 65-72
- 10 Tummala RP, Coscarella E, Morcos JJ. Transpetrosal approaches to the posterior fossa. Neurosurg Focus 2005; 19 (02) E6
- 11 Roche PH, Lubrano VF, Noudel R. How I do it: epidural anterior petrosectomy. Acta Neurochir (Wien) 2011; 153 (06) 1161-1167
- 12 Jittapiromsak P, Sabuncuoglu H, Deshmukh P, Nakaji P, Spetzler RF, Preul MC. Greater superficial petrosal nerve dissection: back to front or front to back?. Neurosurgery 2009; 64 (05) (Suppl. 02) 253-258 , discussion 258–259
- 13 Delwel EJ. The anterior transpetrosal-transtentorial approach (Kawase approach): an anatomic description and clinical applications. Contemp Neurosurg 2008; 30: 1-6
- 14 Watanabe T, Igarashi T, Fukushima T, Yoshino A, Katayama Y. Anatomical variation of superior petrosal vein and its management during surgery for cerebellopontine angle meningiomas. Acta Neurochir (Wien) 2013; 155 (10) 1871-1878
- 15 Kusumi M, Fukushima T, Mehta AI. et al. Tentorial detachment technique in the combined petrosal approach for petroclival meningiomas. J Neurosurg 2012; 116 (03) 566-573
- 16 Youssef S, Kim EY, Aziz KM, Hemida S, Keller JT, van Loveren HR. The subtemporal interdural approach to dumbbell-shaped trigeminal schwannomas: cadaveric prosection. Neurosurgery 2006; 59 (04) (Suppl. 02) ONS270-ONS277 , discussion ONS277–ONS278
- 17 Bulsara KR, Patel T, Fukushima T. Cerebral bypass surgery for skull base lesions: technical notes incorporating lessons learned over two decades. Neurosurg Focus 2008; 24 (02) E11
- 18 Aghi MK, Carter BS, Cosgrove GR. et al. Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery 2009; 64 (01) 56-60 , discussion 60
- 19 Krisht AF. Transcavernous approach to diseases of the anterior upper third of the posterior fossa. Neurosurg Focus 2005; 19 (02) E2
- 20 Tripathi M, Deo RC, Suri A. et al. Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension. J Neurosurg 2015; 123 (01) 14-22
- 21 Fukaya R, Yoshida K, Ohira T, Kawase T. Trigeminal schwannomas: experience with 57 cases and a review of the literature. Neurosurg Rev 2010; 34 (02) 159-171
- 22 Sato S, Oizumi T, Sato M. et al. Enlarged entry space for the transpetrosal approach. Skull Base Surg 2000; 10 (02) 59-63
- 23 Sharma M, Ambekar S, Guthikonda B, Nanda A. A comparison between the Kawase and extended retrosigmoid approaches (retrosigmoid transtentorial and retrosigmoid intradural suprameatal approaches) for accessing the petroclival tumors. A cadaveric study. J Neurol Surg B Skull Base 2014; 75 (03) 171-176