Endoscopic transcanal transpetrosal approach to the petroclival region: a cadaveric study with comparison to the Kawase
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ORIGINAL ARTICLE
Endoscopic transcanal transpetrosal approach to the petroclival region: a cadaveric study with comparison to the Kawase approach Bon-Jour Lin 1 & Da-Tong Ju 1 & Yi-Chieh Wu 1 & Hung-Wen Kao 2 & Kuan-Yin Tseng 1 & Tzu-Tsao Chung 1 & Wei-Hsiu Liu 1 & Dueng-Yuan Hueng 1 & Yuan-Hao Chen 1 & Chung-Ching Hsia 1 & Hsin-I Ma 1 & Ming-Ying Liu 1 & Chi-Tun Tang 1 Received: 29 June 2020 / Revised: 26 August 2020 / Accepted: 4 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract This study introduces expanded application of the endoscopic transcanal approach with anterior petrosectomy (ETAP) in reaching the petroclival region, which was compared through a quantitative analysis to the middle fossa transpetrosaltranstentorial approach (Kawase approach). Anatomical dissections were performed in five cadaveric heads. For each head, the ETAP was performed on one side with a detailed description of each step, while the Kawase approach was performed on the contralateral side. Quantitative measurements of the exposed area over the ventrolateral surface of the brainstem, and of the angles of attack to the posterior margin of the trigeminal nerve root entry zone (CN V-REZ) and porus acusticus internus (PAI) were obtained for statistical comparison. The ETAP provided significantly larger exposure over the ventrolateral surface of the pons (93.03 ± 21.87 mm2) than did the Kawase approach (34.57 ± 11.78 mm2). In contrast to the ETAP, the Kawase approach afforded greater angles of attack to the CN V-REZ and PAI in the vertical and horizontal planes. The ETAP is a feasible and minimally invasive procedure for accessing the petroclival region. In comparison to the Kawase approach, the ETAP allows for fully anterior petrosectomy and larger exposure over the ventrolateral surface of the brainstem without passing through the cranial nerves or requiring traction of the temporal lobe. Keywords Endoscopic transcanal . Anterior petrosectomy . Petroclival . Lateral skull base
Introduction The endoscopic transcanal approach, a newly developed minimally invasive surgery, has been accepted as one practical procedure for managing tympanoplasty and selected middle ear pathology, mainly cholesteatoma [4, 7]. Accompanied by rapid growth in the knowledge of endoscopic ear anatomy, clinical applications of the endoscopic transcanal approach extend, from laterally to medially, into the lesions of the cochlea, vestibule, internal acoustic canal (IAC), and even * Bon-Jour Lin [email protected] * Chi-Tun Tang [email protected] 1
Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, Republic of China
2
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
cerebellopontine angle [14, 17–20, 22]. This evolution is attributed to the natural construction of the auditory canal providing a straight corridor to the tympanic cavity and la
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