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Modified Skin Incision and Location of Burr-Hole Surgery via a Retrosigmoid Approach: An Anatomical StudyFunding The National Natural Science Foundation of China, 0601011501, Xiaochun Jiang; the Natural Science Foundation of Anhui Province, 060108021802 and 060108011802, Xiaochun Jiang.
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.
Keywordsretrosigmoid approach - anatomy - burr-hole surgery - occipital nerve - suboccipital nerve - occipital artery - skull specimen
The study was approved by the Institutional Ethics Committee and performed in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Received: 22 October 2020
Accepted: 12 November 2021
Article published online:
16 January 2022
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