Impact of C-shaped skin incision on surgical operability in the retrosigmoid approach: when a good start is half of the job

2021 ◽  
Author(s):  
Filippo Gagliardi ◽  
Martina Piloni ◽  
Silvia Snider ◽  
Francesca Roncelli ◽  
Edoardo Pompeo ◽  
...  
Keyword(s):  
Skin Incision ◽  
Retrosigmoid Approach

Modified Skin Incision and Location of Burr-Hole Surgery via a Retrosigmoid Approach: An Anatomical Study

2022 ◽  
Author(s):  
Lean Sun ◽  
Min Qi ◽  
Xuefei Shao ◽  
Sansong Chen ◽  
Xinyun Fang ◽  
...  
Keyword(s):  
Blood Vessels ◽  
Tissue Damage ◽  
Cerebellopontine Angle ◽  
Anatomical Study ◽  
Skin Incision ◽  
Sigmoid Sinus ◽  
Burr Hole ◽  
Retrosigmoid Approach ◽  
Positioning Method

Abstract Objective This study aims to reduce the tissue damage during craniotomy with retrosigmoid approach. A modified sickle-shaped skin incision was developed, and a new burr-hole positioning method was proposed. Methods Five adult cadaveric heads (10 sides) were used in this study. The sickle-shaped skin incision was performed during craniotomy. The nerves, blood vessels, and muscles were observed and measured under a microscope. Additionally, 62 dry adult skull specimens (left sided, n = 35; right sided, n = 27) were used to measure the distance between the most commonly used locating point (asterion [Ast] point) and the posteroinferior point of the transverse sigmoid sinus junction (PSTS) (Ast-PSTS), as well as the distance between the new locating O point and the PSTS (O-PSTS). Then, the reliability of the new locating O point was validated on the same five adult cadaveric heads (10 sides) used for the sickle-shaped skin incision. Results The sickle-shaped skin incision reduced the damage to the occipital nerves, blood vessels, and muscles during the surgery via a retrosigmoid approach. The dispersion and variability of O-PSTS were smaller than those of Ast-PSTS. Conclusion The sickle-shaped skin incision of the retrosigmoid approach can reduce the tissue damage and can completely expose the structures in the cerebellopontine angle. The modified O point is a more reliable locating point for a burr-hole surgery than the Ast point.

A Laboratory Investigation on a Tailored Skin and Muscle Flap Variant for the Retrosigmoid Approach

2021 ◽  
Author(s):  
Salvatore Chibbaro ◽  
Helene Cebula ◽  
Ismail Zaed ◽  
Arthur Gubian ◽  
Julien Todeschi ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Skin Flap ◽  
Muscle Flap ◽  
Anatomical Study ◽  
Skin Incision ◽  
Retrosigmoid Approach ◽  
Surgical Approaches ◽  
Muscle Flaps ◽  
Minimal Invasiveness ◽  
Surgical Corridor

Abstract Introduction An anatomical study was conducted to test a modified C-shaped flap designed for patients undergoing a keyhole approach and/or minicraniotomy for retrosigmoid approach (KRSA). Materials and Methods Ten heads specimens were used. The surgical technique investigated was based on a 4-cm C-shaped skin incision with medial convexity (placed 8 cm laterally to the external occipital protuberance, with the lower edge terminating 1.5 to 2 cm above the mastoid tip), which followed by careful subperiosteal dissection and completed by reflecting and securing the skin flap layer anteriorly and the muscle flaps superiorly and inferiorly by stitches. Anatomical findings, including depth of surgical corridor till to the cerebellopontine cistern (CPC) as well as the sparing of neurovascular structures, were evaluated in every specimen. Results Twenty surgical approaches to CPC were conducted, resulting in a short working distance to the target (32 mm) without any need for a self-retaining retractor. In every specimen, the integrity of occipital muscles and cutaneous nerves was maintained, and a solid multilayer closure was always achieved. These data suggest that landmarks-based design of this C-shaped incision could be helpful in avoiding damages to the soft tissues encountered during KRSA. Conclusion This modified approach provides a wide surgical corridor to access the CPC while ensuring the minimal invasiveness of the standard S-shaped incision. Compared with the latter, it preserves better the integrity of the surrounding soft tissues and appears less likely to cause any iatrogenic injury to occipital muscles and cutaneous nerves.

Retromastoid-transmuscular identification and harvest of the occipital artery during retrosigmoid craniotomy

2020 ◽  
Vol 133 (2) ◽  
pp. 538-545 ◽  
Author(s):  
Ali Tayebi Meybodi ◽  
Michael T. Lawton ◽  
Leandro Borba Moreira ◽  
Xiaochun Zhao ◽  
Michael J. Lang ◽  
...  
Keyword(s):  
Reliable Method ◽  
Muscle Fibers ◽  
External Auditory Meatus ◽  
Skin Incision ◽  
Sternocleidomastoid Muscle ◽  
Posterior Circulation ◽  
Entire Length ◽  
Retrosigmoid Approach ◽  
Occipital Artery ◽  
Splenius Capitis

OBJECTIVEHarvesting the occipital artery (OA) is challenging. The subcutaneous OA is usually found near the superior nuchal line and followed proximally, requiring a large incision and risking damage to the superficially located OA. The authors assessed the anatomical feasibility and safety of exposing the OA through a retromastoid-transmuscular approach.METHODSUsing 10 cadaveric heads, 20 OAs were harvested though a 5-cm retroauricular incision placed 5 cm posterior to the external auditory meatus. The underlying muscle layers were sequentially cut and recorded before exposing the OA. Changes in the orientation of muscle fibers were used as a roadmap to expose the OA without damaging it.RESULTSThe suboccipital segment of the OA was exposed without damage after incising two consecutive layers of muscles and their investing fasciae. These muscles displayed different fiber directions: the superficially located sternocleidomastoid muscle with vertically oriented fibers, and the underlying splenius capitis with anteroposteriorly (and mediolaterally) oriented fibers. The OA could be harvested along the entire length of the skin incision in all specimens. If needed, the incision can be extended proximally and/or distally to follow the OA and harvest greater lengths.CONCLUSIONSThis transmuscular technique for identification of the OA is a reliable method and may facilitate exposure and protection of the OA during a retrosigmoid approach. This technique may obviate the need for larger incisions when planning a bypass to nearby arteries in the posterior circulation via a retrosigmoid craniotomy. Additionally, the small skin incision can be enlarged when a different craniotomy and/or bypass is planned or when a greater length of the OA is needed to be harvested.

Retrosigmoid Approach to Acoustic Neuroma (Vestibular Schwannoma)

Neurosurgery ◽  
2001 ◽  
Vol 48 (3) ◽  
pp. 553-558 ◽  
Author(s):  
Robert G. Ojemann
Keyword(s):  
Vestibular Schwannoma ◽  
Acoustic Neuroma ◽  
Skin Incision ◽  
Retrosigmoid Approach ◽  
Nerve Function ◽  
Initial Exposure ◽  
Bone Removal ◽  
Acoustic Neuromas ◽  
Oblique Position ◽  
Dural Opening

Abstract THE RETROSIGMOID APPROACH for the microsurgical removal of an acoustic neuroma (vestibular schwannoma) is described, and perioperative medical management of the patient is discussed. The techniques for monitoring facial and cochlear nerve function are presented. The supine-oblique position, skin incision, bone removal, dural opening, and initial exposure are outlined. Important points in the technique for removing acoustic neuromas and preserving hearing, when possible, are described and illustrated.

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Retrosigmoid Approach

2019 ◽  
Author(s):  
Christopher S. Graffeo ◽  
Maria Peris-Celda ◽  
Avital Perry ◽  
Lucas P. Carlstrom ◽  
Colin L.W. Driscoll ◽  
...  
Keyword(s):  
Skull Base ◽  
Three Dimensional ◽  
Skin Incision ◽  
Surgical Anatomy ◽  
Retrosigmoid Approach ◽  
Muscle Flaps ◽  
Wide Clinical Application ◽  
Lateral Suboccipital Approach ◽  
Key Steps ◽  
Flap Elevation

Abstract Introduction Neurosurgical anatomy is traditionally taught via anatomic and operative atlases; however, these resources present the skull base using views that emphasize three-dimensional (3D) relationships rather than operative perspectives, and are frequently written above a typical resident's understanding. Our objective is to describe, step-by-step, a retrosigmoid approach dissection, in a way that is educationally valuable for trainees at numerous levels. Methods Six sides of three formalin-fixed latex-injected specimens were dissected under microscopic magnification. A retrosigmoid was performed by each of three neurosurgery residents, under supervision by the senior authors (C.L.W.D. and M.J.L.) and a graduated skull base fellow, neurosurgeon, and neuroanatomist (M.P.C.). Dissections were supplemented with representative case applications. Results The retrosigmoid craniotomy (aka lateral suboccipital approach) affords excellent access to cranial nerve (CN) IV to XII, with corresponding applicability to numerous posterior fossa operations. Key steps include positioning and skin incision, scalp and muscle flaps, burr hole and parasigmoid trough, craniotomy flap elevation, initial durotomy and deep cistern access, completion durotomy, and final exposure. Conclusion The retrosigmoid craniotomy is a workhorse skull base exposure, particularly for lesions located predominantly in the cerebellopontine angle. Operatively oriented neuroanatomy dissections provide trainees with a critical foundation for learning this fundamental skull base technique. We outline a comprehensive approach for neurosurgery residents to develop their familiarity with the retrosigmoid craniotomy in the cadaver laboratory in a way that simultaneously informs rapid learning in the operating room, and an understanding of its potential for wide clinical application to skull base diseases.

Retrosigmoid Craniectomy with a Layered Soft Tissue Dissection and Hydroxyapatite Reconstruction: Technical Note, Surgical Video, Regional Anatomy, and Outcomes

2021 ◽  
Author(s):  
Stephen T. Magill ◽  
Young M. Lee ◽  
Roberto R. Rubio ◽  
Minh P. Nguyen ◽  
Carl B. Heilman ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Skin Incision ◽  
Technical Note ◽  
Retrosigmoid Approach ◽  
Regional Anatomy ◽  
Surgical Video ◽  
Soft Tissue Dissection ◽  
Tissue Dissection ◽  
Tissue Flap ◽  
Over The Top

Abstract Background There are many reported modifications to the retrosigmoid approach including variations in skin incisions, soft tissue dissection, bone removal/replacement, and closure. Objective The aim of this study was to report the technical nuances developed by two senior skull base surgeons for retrosigmoid craniectomy with reconstruction and provide anatomic dissections, surgical video, and outcomes. Methods The regional soft tissue and bony anatomy as well as the steps for our retrosigmoid craniectomy were recorded with photographs, anatomic dissections, and video. Records from 2017 to 2019 were reviewed to determine the incidence of complications after the authors began using the described approach. Results Dissections of the relevant soft tissue, vascular, and bony structures were performed. Key surgical steps are (1) a retroauricular C-shaped skin incision, (2) developing a skin and subgaleal tissue flap of equal thickness above the fascia over the temporalis and sub-occipital muscles, (3) creation of subperiosteal soft tissue planes over the top of the mastoid and along the superior nuchal line to expose the suboccipital region, (4) closure of the craniectomy defect with in-lay titanium mesh and overlay hydroxyapatite cranioplasty, and (5) reapproximation of the soft tissue edges during closure. Complications in 40 cases were pseudomeningocele requiring shunt (n = 3, 7.5%), wound infection (n = 1, 2.5%), and aseptic meningitis (n = 1, 2.5%). There were no incisional cerebrospinal fluid leaks. Conclusions The relevant regional anatomy and a revised technique for retrosigmoid craniectomy with reconstruction have been presented with acceptable results. Readers can consider this technique when using the retrosigmoid approach for pathology in the cerebellopontine angle.

Retrosigmoid Approach: Investigating the Role of a C-Shaped Skin Incision and Muscle Flaps in Improving Functional Outcome and Reducing Postoperative Pain

2018 ◽  
Vol 111 ◽  
pp. e340-e347 ◽  
Author(s):  
Salvatore Chibbaro ◽  
Hélène Cebula ◽  
Antonino Scibilia ◽  
Giorgio Spatola ◽  
Julien Todeschi ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Functional Outcome ◽  
Skin Incision ◽  
Retrosigmoid Approach ◽  
Muscle Flaps

Minimally Invasive Repair of Pectus Excavatum (MIRPE) - The Basel Experience

Swiss Surgery ◽  
2003 ◽  
Vol 9 (6) ◽  
pp. 289-295 ◽  
Author(s):  
Haecker ◽  
Bielek ◽  
von Schweinitz
Keyword(s):  
Minimally Invasive ◽  
Pectus Excavatum ◽  
Pulmonary Function Tests ◽  
Preoperative Evaluation ◽  
Skin Incision ◽  
Original Method ◽  
Restrictive Lung Disease ◽  
Cardiac Compression ◽  
Cardiac Evaluation ◽  
Indications For Operation

Purpose: Minimally invasive repair of pectus excavatum (MIRPE) was first reported in 1998 by D. Nuss. This technique has gained wide acceptance during the last 4-5 years. In the meantime, some modifications of the technique have been introduced by different authors. Our retrospective study reports our own experience over the last 36 months and modifications introduced due to a number of complications. Methods: From 3/2000 to 3/2003, 22 patients underwent MIRPE. Patients median age was 15.5 years (10.7 to 20.3 years). Standardised preoperative evaluation included 3D computerised tomography (CT) scan, pulmonary function tests, cardiac evaluation with electrocardiogram and echocardiography, and photo documentation. Indications for operation included at least two of the following: Haller CT index > 3.2, restrictive lung disease, cardiac compression, progression of the deformity and severe psychological alterations. Results: In 22 patients (2 girls, 20 boys) undergoing MIRPE procedure, a single bar was used in 21 patients and two bars in one boy. Lateral stabilisers were fixed with non resorbable sutures on both sides. Overall, postoperative complications occurred in six patients (27.3%). In two patients (9.1%) a redo-procedure was necessary due to bar displacement. An additional median skin incision was performed in two patients to elevate the sternum. Pneumothorax or hematothorax in two patients resulted in routine use of a chest tube on both sides. Long-term favourable results were noted in all patients. Conclusions: The MIRPE procedure is an effective method with elegant cosmetic results. Modifications of the original method help to decrease the complication rate and to accelerate acquirement of expertise.

Extended Retrolabyrinthine/Retrosigmoid Approach to a Transmastoid, Intracranial Speargun Injury

2015 ◽  
Vol 76 (S 01) ◽  
Author(s):  
Guyan Channer ◽  
Mark Morgan ◽  
Natalie Whylie ◽  
Stephen Chang ◽  
Warren Mullings ◽  
...  
Keyword(s):  
Retrosigmoid Approach
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