Kawase's Approach for Petrous Apex Lesions

Objective: To describe the use of the Kawase's approach in the management of neoplastic lesions involving the anterior petrous apex.

Study Design: Retrospective case review.

Setting: Tertiary referral center.

Patients: Three patients with normal hearing presented with known or suspected neoplastic petrous apex lesions.

Interventions: A large middle fossa bone flap was elevated in each case. An extradural approach was used to expose the petrous ridge, which included division of the middle meningeal artery. The horizontal petrous carotid artery was exposed in each case and served as the anterior lateral limit of dissection. An anterior petrosectomy was performed, and the lesion was removed in each case.

Results: Near total tumor excision was achieved in each case with preservation of hearing at preoperative levels. One patient presented with preoperative visual impairment and ophthalmoplegia, which did not improve with surgery. No patient developed a cerebrospinal leak, facial weakness, or other cranial nerve deficits.

Conclusions: Kawase's approach is a reasonable alternative in the management of neoplastic anterior petrous apex lesions with normal preoperative hearing.