ArticleFrontiers in surgery2026
Morphometric anatomy of the middle cranial fossa via the anterior petrosal (Kawase) approach: a bilateral cadaveric study.
Article in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The anterior petrosal (Kawase) approach is a well-established extradural corridor to the petroclival and upper clival regions; however, comprehensive bilateral morphometric data describing middle cranial fossa anatomy, particularly in Southeast Asian populations, remain limited. Objective: To provide a comprehensive morphometric description of the microsurgical anatomy of the middle cranial fossa through the anterior petrosal (Kawase) approach based on bilateral cadaveric dissections. Methods: A descriptive cadaveric study was performed on 21 formalin-fixed adult Vietnamese cadaveric heads (42 sides). Standardized extradural dissections following the anterior petrosal approach were conducted, and predefined linear and angular morphometric measurements of key osseous, neural, and vascular landmarks were obtained bilaterally. Results: The greater superficial petrosal nerve (GSPN), trigeminal ganglion, cochlea, internal auditory canal (IAC), superior semicircular canal, and petrous internal carotid artery were consistently identified in all specimens. The mean GSPN length was 10.66 ± 2.44 mm. Key inter-foraminal and neurovascular distances included a mean distance of 29.68 ± 1.97 mm from the foramen spinosum to the zygomatic root and 11.70 ± 2.44 mm between the foramen ovale and foramen rotundum. Cochlear-related measurements demonstrated mean distances of 3.39 ± 0.98 mm to the geniculate ganglion and 4.56 ± 1.29 mm to the internal carotid artery genu. Angular analysis showed a mean angle of 121.82 ± 15.38° between the GSPN and arcuate eminence, 104.07 ± 13.25° between the GSPN and superior semicircular canal, and 45.42 ± 12.09° between the IAC and superior semicircular canal. Paired right-left comparisons demonstrated overall bilateral symmetry across most linear and angular parameters, with a significant side-to-side difference observed only in the IAC-SSC angle. Conclusions: This study provides a comprehensive bilateral morphometric characterization of the middle cranial fossa via the anterior petrosal approach in a Vietnamese population. The findings confirm the reliability of key anatomical landmarks, delineate their spatial relationships, and demonstrate predominantly bilateral symmetry, thereby offering population-specific anatomical data that may support surgical planning, neuronavigation, and training in skull base surgery.
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