Applied and anatomic observation of two methods for locating related bony anatomic landmarks associated with the Kawase triangle in the intradural anterior subtemporal transpetrosal approach
Jiang Lei, Qian Ming, Wang Xuejian, Wang Zhifeng, Chen yang, Zhang Yi
Department of Neurosurgery, Affiliated Hospital 2 of Nantong University, Nantong 226000, China
Abstract：Objective This study aimed to explore a suitable method for locating related bony structures in the intradural anterior subtemporal transpetrosal approach under endoscopy and to provide anatomical basis for clinical practice. Methods (1) The following were marked on 16 dry skulls: the highest point of arcuate eminence (A), petrous apex (P), most lateral point of groove for the greater petrosal nerve (B), foramen spinosum (C), foramen ovale (D), trigeminal impression (E), foramen lacerum (F) and intersective point of the lateral margin of the petrous ridge and the anterior edge of the transverse sinus (J). Methoda used point A as the reference point, line PJ as the baseline, and line AP1 as the parallel line of baseline. Points B, C, D, E, and F were passed as the vertical line of AP1. The intersection points were B1, C1, D1, E1, and F1. The lengths of AB, AC, AD, AE, AF, BB1, CC1, DD1, EE1, and FF1 were measured, and the angles of ∠BAP1, ∠CAP1, ∠DAP1, ∠EAP1, and ∠FAP1 were calculated using trigonometric functions. Methodb used point A as reference point and line AP as the baseline. The length of AB, AC, AD, AE, AF, AP were measured, and the angle of ∠BAP, ∠CAP, ∠DAP, ∠EAP, and ∠FAP were calculated using trigonometric functions. (2) Two wet head specimens were provided, and one female aged 47 years and one male aged 61 years were selected. The positions of points B, C, D, E, and F were located according to the relevant angle and line length measured on the skull specimen by using the two positioning methods. According to the positioning of anatomical landmarks, the Kawase triangle was exposed and the bone window was ground out. The operation time from suspending the dura to cutting the Kawase triangle dura and the size of the ground bone window were measured. We further determined whether the superficial greater petrosal nerve, the mandibular branch of trigeminal nerve, and the superior petrosal sinus were injured or disconnected during the simulated operation of the two localization methods to evaluate the clinical applicability of the two localization methods. Results (1) The lengths of AB, AC, AD, AE, AF, BB1, CC1, DD1, EE1, and FF1 measured by method a were (11.41±1.22), (23.99±1.17), (30.36±1.60), (22.22±2.95), (32.08±2.29), (3.92±0.82), (10.82±1.53), (10.88±1.73), (1.10±1.23), and (2.24±2.10) mm, respectively. The angles ∠BAP1, ∠CAP1, ∠DAP1, ∠EAP1, and ∠FAP1 were 20.1°±4.0°, 26.8°±4.9°, 21.0°±4.8°, 2.8°±5.0°, and 4.0°±4.0°, respectively. The lengths of AB, AC, AD, AE, AF, and AP measured by method b were (11.03±2.36), (22.11±2.92), (24.66±3.00), (19.10±2.94), (29.46±2.57), (29.83±3.37) mm, respectively. The angles ∠BAP, ∠CAP, ∠DAP, ∠EAP, and ∠FAP were 51.0°±12.7°, 47.0°±7.6°, 40.1°±4.1°, 23.9°±5.9°, and 16.6°±3.03°, respectively. (2) Using the anatomical data of methods a and b, the relevant bone structures in the subdural anterior petrosal approach were located, and no peripheral nerve and blood vessel injury were found. For method a, the operation time from suspending the dura to cutting the Kawase triangle dura was 5 min 48 s and 6 min 47 s, and the ground bone window was 27.90 mm×41.08 mm and 34.24 mm×46.26 mm. For method b, the operation time from suspending the dura to cutting the Kawase triangle dura was 4 min 7 s and 4 min 57 s, and the ground bone window was 24.54 mm×33.72 mm and 28.14 mm×41.4 mm. Conclusion In the neuroendoscopic intradural anterior subtemporal transpetrosal approach, the arcuate eminence is used as the reference point. The line between and the highest point of the arcuate eminence and the petrous apex are used as the baseline, which can accurately locate the relevant bone structures during operation. This positioning method is more suitable for clinical surgery.
姜雷, 钱明, 王学建, 汪志峰, 陈杨, 张毅. 神经内镜硬膜下岩前入路中2种Kawase三角相关骨性解剖标志定位方法的应用解剖学观察[J]. 中华解剖与临床杂志, 2023, 28(4): 224-229.
Jiang Lei, Qian Ming, Wang Xuejian, Wang Zhifeng, Chen yang, Zhang Yi. Applied and anatomic observation of two methods for locating related bony anatomic landmarks associated with the Kawase triangle in the intradural anterior subtemporal transpetrosal approach. Chinese Journal of Anatomy and Clinics, 2023, 28(4): 224-229.
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2023, Vol. 28 
