The Kawase Approach to Retrosellar and Upper Clival Basilar Aneurysms

Km, Aziz; Hr, van Loveren; Jm, Tew; Mr, Chicoine

doi:10.1097/00006123-199906000-00033

Cited by 36 publications

(3 citation statements)

References 18 publications

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“…A picture of Kawase's approach first appeared on the cover of the journal Neurosurgery in 1999. 14 Kawase himself had never referred to this approach as his own, and the international recognition took him by surprise.…”

Section: The First Successful "Kawase Approach" At Ashikaga Red Cross...mentioning

confidence: 99%

The historical adventures of Takeshi Kawase: the mountaineer who explored the "no man’s land" with love for art, nature, and humankind

Ganaha,

Shibao

2024

Journal of Neurosurgery

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The anterior petrosal approach, or Kawase’s approach, is a commonly used technique in skull base surgery to access the brainstem in the posterior fossa from the middle fossa, and has the advantages of minimizing brain retraction and preserving hearing. It was first successfully performed by the legendary Japanese neurosurgeon, Takeshi Kawase, for the clipping of a basilar artery aneurysm in 1981. To date, no historical article has shed light on Kawase’s intriguing personal history. In this historical vignette, the authors depict Kawase’s unique background, talent, passion, as well as struggles that ultimately shaped his career. By sharing Kawase’s personal story from the hospital where he first successfully performed his original approach, the authors hope to pass on to future generations Kawase’s spirit and philosophy that have impacted the global neurosurgical community.

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Section: The First Successful "Kawase Approach" At Ashikaga Red Cross...mentioning

confidence: 99%

The historical adventures of Takeshi Kawase: the mountaineer who explored the "no man’s land" with love for art, nature, and humankind

Ganaha,

Shibao

2024

Journal of Neurosurgery

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“…were consulted to score how confidently they were able to identify relevant structures in particular neurosurgical procedures on the i model vs patients' radiological images (PRIs), on a scale from 0 (not confident in identification of the structure at all) to 10 (100% confident). The key anatomic structures were selected for this analysis by referring to published literature on the anterior petrosal approach (APA) for trigeminal schwannoma, [25][26][27][28] and supracerebellar infratentorial approach (SIA) for resection of pontine cavernous malformation (CM). 29 Those 2 approaches were selected because they both require understanding of more complex neuroanatomy in the skull base and brainstem than more superficial procedures.…”

Section: Comparison Of Clear Visibility Of Anatomy Between the I Mode...mentioning

confidence: 99%

Development of Integrated 3-Dimensional Computer Graphics Human Head Model

et al. 2021

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BACKGROUND Understanding the complex anatomy of neurostructures is very important in various stages of medical education, from medical students to experienced neurosurgeons, and, ultimately, for the knowledge of human beings. OBJECTIVE To develop an interactive computer graphics (CG) anatomic head model and present the current progress. METHODS Based on the prior head 3-dimensional CG (3DCG) polygon model, 23 additional published papers and textbooks were consulted, and 2 neurosurgeons and 1 CG technician performed revision and additional polygon modeling. Three independent neurosurgeons scored the clear visibility of anatomic structures relevant to neurosurgical procedures (anterior petrosal and supracerebellar infratentorial approaches) in the integrated 3DCG model (i model) and patients’ radiological images (PRIs) such as those obtained from computed tomography, magnetic resonance imaging, and angiography. RESULTS The i model consisted of 1155 parts (.stl format), with a total of 313 763 375 polygons, including 10 times more information than the foundation model. The i model was able to illustrate complex and minute neuroanatomic structures that PRIs could not as well as extracranial structures such as paranasal sinuses. Our subjective analysis showed that the i model had better clear visibility scores than PRIs, particularly in minute nerves, vasculatures, and dural structures. CONCLUSION The i model more clearly illustrates minute anatomic structures than PRIs and uniquely illustrates nuclei and fibers that radiological images do not. The i model complements cadaveric dissection by increasing accessibility according to spatial, financial, ethical, and social aspects and can contribute to future medical education.

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“…Notwithstanding, the maximal range of the AP is limited medially by the abducens nerve at Dorello's canal, and inferiorly by the IAC and IPS, resulting in a relatively narrow range of appropriate clinical indications, mirroring the physical narrowness of the operative corridor. [23][24][25][26][27] In our practice, MF lesions with a small extension through the Kawase space are well managed by the AP, but, for tumors with more significant posterior fossa components, we prefer the retrosigmoid craniotomy, or the posterior petrosectomy. 22,27,28 Regarding closure, the air cells exposed after the AP are thoroughly waxed and an autologous fat graft is harvested from the abdomen and used over the AP defect.…”

Section: Clinical Considerations: Mf and Mf With Iac Exposurementioning

confidence: 99%

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Middle Fossa Approaches and Anterior Petrosectomy, Surgical Principles, and Illustrative Cases

Salgado-López

Perry

Graffeo

et al. 2021

J Neurol Surg B Skull Base

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Introduction The middle fossa (MF) approaches encompass a group of versatile surgical accesses to pathologies in the MF, internal auditory canal (IAC), and superomedial aspect of the posterior fossa. Although many descriptions of the MF approaches have been published, a practical surgical guide that allows an easy understanding for Skull Base trainees is needed. Methods Three formalin-fixed, colored-injected specimens were dissected under microscopic magnification (six sides). A MF craniotomy followed by IAC drilling was performed on three sides, and anterior petrosectomy (AP) was performed in the remaining three sides. The anatomical dissection was documented in stepwise three-dimensional photographic images. Following dissection, representative case applications were reviewed. Results The MF approach provides direct access to the MF structures and IAC. The AP provides excellent access to the superomedial aspect of the posterior fossa. Key common steps include: positioning and skin incision; scalp and muscle flaps; burr holes; craniotomy flap elevation; dural dissection along the petrous ridge; division of the middle meningeal artery; and exposure of the greater superficial petrosal nerve, tegmen tympani, and V3. Then, to approach the IAC: superior IAC drilling, and longitudinal dura opening. The area drilled in the AP approach forms a pentagon limited by the petrous internal carotid artery, cochlea, IAC, petrous ridge, and lateral border of V3. Conclusion The MF approaches are challenging. Operatively oriented skull base dissections provide a crucial foundation for learning these techniques. We describe comprehensive step-by-step approaches intended to develop familiarity in the cadaver laboratory and facilitate understanding of their potential for skull base disorders. Basic surgical principles are described to help in the operating room as well as illustrative cases.

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The Kawase Approach to Retrosellar and Upper Clival Basilar Aneurysms

Cited by 36 publications

References 18 publications

The historical adventures of Takeshi Kawase: the mountaineer who explored the "no man’s land" with love for art, nature, and humankind

The historical adventures of Takeshi Kawase: the mountaineer who explored the "no man’s land" with love for art, nature, and humankind

Development of Integrated 3-Dimensional Computer Graphics Human Head Model

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Middle Fossa Approaches and Anterior Petrosectomy, Surgical Principles, and Illustrative Cases

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