The Krause approach: MRI measurements in the Chinese population

We undertook this study to provide anatomical guidance for preoperative positioning for surgery in the pineal region. The anatomical differences between different ages and sexes were obtained by measuring relevant anatomical parameters on imaging of the infratentorial supracerebellar approach (the Krause approach). MRI of 262 healthy Chinese patients were included (232 adults, 30 children). The depth of the infratentorial supracerebellar approach, the angle between the tentorium cerebelli (the approach orientation) and the glabella–external occipital protuberance line, and the angle between the tentorium cerebelli and the dorsum sellae–external occipital protuberance line were measured and analyzed. In adults, the angle between the infratentorial supracerebellar approach and the glabella–external occipital protuberance line was 35.7° ± 6.3° (mean ± standard deviation [SD]), greater than the same angle in children, 29.3° ± 5.0° (p < 0.01). In adults, the angle (mean ± SD) between the approach orientation and the dorsum sellae–external occipital protuberance line was 36.2° ± 5.0°, greater than the same angle in children, 30.7° ± 4.5° (p < 0.01). The depth of the Krause approach (mean ± SD) was 51.30 mm ± 4.66 mm in men and 47.58 mm ± 4.29 mm in women (p < 0.01), while in children the approach depth was 50.47 mm ± 2.62 mm, with no statistical difference between children and adults (p > 0.05). For surgery using the Krause approach in adults, the inclination angle of the tentorium cerebelli and the depth provided by the median sagittal MRI are instructive for preoperative head positioning and intraoperative management. The angle between the approach orientation and the easily observed glabella–external occipital protuberance line can be used to achieve appropriate preoperative positioning and reduce the surgical risk.