Gardner's Triangle: Surgical Anatomy and Relevance for Endoscopic Endonasal Approach to the Petrous Apex and Petroclival Region

Objectives: This study aimed to describe a medial petrous triangle (Gardner's triangle) as a reliable access corridor for trans-sinus approaches to the petrous apex (PA) and petroclival region (PCR).

Design: The PA and PCR were accessed either through endoscopic endonasal approach (EEA) or contralateral transmaxillary (CTM) approach in five human anatomical specimens. The limits of Gardner's triangle were identified and dissected in all specimens, and later reproduced in five real cases.

Results: The medial petrous triangle is defined by (1) the abducens nerve posteromedially, (2) paraclival internal carotid artery anterolaterally, and (3) petroclival synchondrosis inferiorly. Five patients with lesions involving the PA and/or PCR (two meningiomas, two chondrosarcomas, and one chordoma) were selected and underwent surgery through an endoscopic approach. Gardner's triangle provided reliable, safe and reproducible anatomical access via the sphenoid sinus to reach the PA and PCR providing additional lateral access.

Conclusion: Classically, the approach to PA and PCR lesions is challenging due to the critical neurovascular structures that surround this area. The identification of key anatomical landmarks of a medial petrous triangle is a critical surgical step and its use as a surgical technique allows for a safe and effective surgery in the petrous region ([Figs. 1]–[4]).

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
15 February 2022