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Importance of Sufficient Petrosectomy in an Anterior Petrosal Approach: Relightening of the Kawase Pyramid

 In-Ho Jung  ;  Jihwan Yoo  ;  Tae Hoon Roh  ;  Hun Ho Park  ;  Chang-Ki Hong 
 WORLD NEUROSURGERY, Vol.153 : e11-e19, 2021-09 
Journal Title
Issue Date
Cranial Fossa, Posterior / surgery ; Female ; Humans ; Logistic Models ; Male ; Margins of Excision ; Meningeal Neoplasms / diagnostic imaging ; Meningeal Neoplasms / pathology ; Meningeal Neoplasms / surgery* ; Meningioma / diagnostic imaging ; Meningioma / pathology ; Meningioma / surgery* ; Middle Aged ; Neurosurgical Procedures / methods* ; Organ Size ; Petrous Bone / surgery* ; Tumor Burden
Anterior petrosal approach ; Kawase pyramid ; Petroclival meningioma ; Skull base surgery
Background: In 1985, Kawase published an anterior petrosal approach to expose the posterior cranial fossa and to minimize retraction of the temporal lobe. However, some neurosurgeons still have difficulty with removing tumors through an anterior petrosal approach because a complete understanding of the Kawase pyramid has not been achieved. We hypothesized that if anterior petrosectomy were performed with three-dimensional understanding of the Kawase pyramid, it would have a positive effect on extent of tumor resection.

Methods: We performed a retrospective study of patients who underwent surgical treatment for meningioma through an anterior petrosal approach. Patients were divided into total resection and subtotal resection groups, and statistical differences between the groups were analyzed. To identify factors predictive of complete tumor removal, univariable and multivariable logistic regression analyses were performed.

Results: Width and height of the drilled internal auditory canal of the total resection group were significantly larger than those of the subtotal resection group (P = 0.001, P = 0.033). The operative angle of the total resection group was significantly larger than that of the subtotal resection group (P < 0.001). Regression analyses showed only drilled internal auditory canal width to be predictive of complete tumor removal, increasing the likelihood of complete tumor removal by 2.778-fold with an increase in drilled internal auditory canal width by 1 mm (P = 0.023).

Conclusions: Insufficient petrosectomy during an anterior petrosal approach adversely affects the extent of tumor resection. Furthering three-dimensional understanding of the Kawase pyramid could aid in complete tumor resection and better outcomes without causing damage to the surrounding organs.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Hun Ho(박현호) ORCID logo https://orcid.org/0000-0002-2526-9693
Yoo, Jihwan(유지환)
Jung, In-Ho(정인호)
Hong, Chang Ki(홍창기) ORCID logo https://orcid.org/0000-0002-2761-0373
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