History, Variations, and Extensions of the Retrosigmoid Approach: Anatomical and Literature Review

Jaafar Basma; Christos Anagnostopoulos; Andrei Tudose; Mikhail Harty; L. Madison Michael II; Mario Teo; David G. Porter

doi:10.1055/s-0041-1729177

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2022; 83(S 02): e324-e335
DOI: 10.1055/s-0041-1729177

Original Article

History, Variations, and Extensions of the Retrosigmoid Approach: Anatomical and Literature Review

Authors

Jaafar Basma

¹Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States

²Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
Christos Anagnostopoulos

²Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
Andrei Tudose

²Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
Mikhail Harty

²Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
L. Madison Michael II

¹Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States

³Semmes-Murphey Clinic, Memphis, Tennessee, United States
Mario Teo

²Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
David G. Porter

²Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom

Abstract

The retrosigmoid approach is the workhorse for posterior fossa surgery. It gives a versatile corridor to tackle different types of lesions in and around the cerebellopontine angle. The term “extended” has been used interchangeably in the literature, sometimes creating confusion. Our aim was to present a thorough analysis of the approach, its history, and its potential extensions. Releasing cerebrospinal fluid from the subarachnoid spaces and meticulous microsurgical techniques allowed for the emergence of the retrosigmoid approach as a unilateral variation of the traditional suboccipital approach. Anatomical landmarks are helpful in localizing the venous sinuses and planning the craniotomy, and Rhoton's rule of three is the key to unlock difficult neurovascular relationships. Extensions of the approach include, among others, the transmastoid, supracerebellar, far-lateral, jugular foramen, and perimeatal approaches. The retrosigmoid approach applies to a broad range of pathologies and, with its extensions, can provide adequate exposure, obviating the need for extensive and complicated approaches.

Keywords

retrosigmoid approach - posterior fossa - history - neuroanatomy - craniotomy

Full Text

References

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