article · Clinical Anatomy
The asterion is a cranial suture landmark commonly referenced during surgical access to the posterior cranial fossa, but its position varies across populations. An anatomical evaluation of ninety adult Kenyan skulls, comprising fifty-one males and thirty-nine females, assessed the distance from the asterion to the root of the zygoma and the mastoid process tip, alongside its relation to the transverse-sigmoid sinus junction. The distance from the asterion to the root of the zygoma averaged approximately 58.85 millimetres on the right and 58.44 millimetres on the left. The height above the mastoid tip averaged 47.89 millimetres on the right and 47.62 millimetres on the left, measuring significantly higher in males than in females. In most instances, the asterion lay directly at the venous sinus junction, suggesting that surgical entry should proceed posteroinferiorly to avoid sinus laceration.
Cranial surgery requires exact surface landmarks to guide bone openings without damaging delicate underlying structures. Because skull anatomy varies between different geographic groups, establishing precise local benchmarks helps neurosurgeons operate more safely. Identifying where the asterion sits relative to major venous sinuses reduces the risk of severe haemorrhage during operations near the posterior cranial fossa.
These anatomical measurements offer immediately applicable reference data for neurosurgeons planning posterolateral skull-base procedures. The findings can also inform the calibration of surgical navigation software and procedural training programmes. As an anatomical observational study, this work provides clinical guidance rather than a standalone commercial product, representing baseline data that can be integrated into existing surgical workflows and medical planning tools.
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The asterion, defined as the junction between lambdoid, parietomastoid, and occipitomastoid sutures, has been used as a landmark in posterolateral approaches to the posterior fossa. Its reliability however has been put into question due to its population-specific variability in position, using external palpable landmarks and its relation to the transverse-sigmoid sinus complex. This study aimed at determining the anatomic position of the asterion in a Kenyan population. Measurements from the asterion to the root of zygoma and the tip of mastoid process, respectively were taken on both left and right sides of 90 (51 male, 39 female) human skulls. The relation of the asterion to the transverse-sigmoid sinus junction was also determined. The distances on the right and left sides from the asterion to the root of the zygoma were 58.85 +/- 2.50 mm and 58.44 +/- 2.12 mm, respectively. The asterion was 47.89 +/- 3.72 mm above the tip of mastoid process on the right side and 47.62 +/- 2.87 mm on the left side. This point was significantly higher in males (48.36 +/- 2.72 mm) than in females (46.62 +/- 3.37 mm) with a P-value of 0.041. Regarding its position from the transverse-sigmoid sinus junction, it was at the junction in 72 cases, below it in 17 cases (average 3.68 mm) and only one case had the asterion above this junction (2.57 mm). The asterion therefore can reliably be ascertained using the parameters from the root of the zygoma and the tip of the mastoid process. The safest approach would be posteroinferior to the asterion so as to avoid lacerating the transverse-sigmoid sinus complex.
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DOI: 10.1002/ca.20888
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