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

  • Original Article - Neurosurgical Anatomy
  • Published:
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Abstract

Background

The retrosigmoid approach (RSA) is one of the routes of choice to approach tumors and vascular lesions of the cerebellopontine angle. Among different types of skin incisions and soft tissue dissection techniques, the most widely used variants comprise the straight/lazy S-shaped and the C-shaped incisions. Several reports discuss advantages in terms of functional and clinical outcomes of the C-shaped incision, but scientific considerations about the critical impact of this kind of incision on surgical operability are still extremely limited.

Object

Authors comparatively analyze the advantage provided by C-shaped incision in RSA in terms of anatomic exposure and surgical operability, compared with straight/lazy S-shaped one.

Methods

A comparative microanatomical laboratory investigation was conducted. The operability score (OS) was applied for quantitative analysis of surgical operability.

Results

C-shaped incision, providing a significant reduction of the overall working distance (–13%) together with an overall increase of the maneuverability area (+ 204.9%), did improve the conizing effect on the surgical corridor. It optimized overall maneuverability of surgical instruments, in terms of angle of attack (+ 27.7%), as well as maneuverability arc (+ 122%), on the entire surgical field.

C-shaped incision ensured good operability on all surgical targets (OS ranging from 2 to 3), most significantly improving surgical maneuverability at the porus trigeminus and internal acoustic meatus.

Conclusion

C-shaped incision in the RSA significantly improves anatomic exposure and surgical operability as compared with straight/lazy S-shaped incision.

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Abbreviations

CH:

Cerebellar hemisphere

F:

Flocculus

IAM:

Internal acoustic meatus

III:

Third cranial nerve

LCN:

Lower cranial nerves

PC:

Posterior clinoid

PCA:

Posterior cerebral artery

PV:

Petrosal vein

V:

Fifth cranial nerve

VII:

Seventh cranial nerve

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Author information

Authors and Affiliations

  1. Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy

    Filippo Gagliardi, Martina Piloni, Silvia Snider, Francesca Roncelli, Edoardo Pompeo & Pietro Mortini

  2. Department of Neurological Surgery, The George Washington University, Washington, DC, USA

    Anthony J. Caputy

Authors
  1. Filippo Gagliardi
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  2. Martina Piloni
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  3. Silvia Snider
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  4. Francesca Roncelli
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  5. Edoardo Pompeo
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  6. Anthony J. Caputy
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  7. Pietro Mortini
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Corresponding author

Correspondence to Filippo Gagliardi.

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Being an anatomic cadaveric study, this article does not contain any studies with living human participants or animals performed by any of the authors.

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Comments

Most relevant and well-illustrated cadaver study comparing the C- versus the straight/lasy S skin incision for surgical access, manoeuvrability, and microscopic vision in the cerebellopontine angle. A proper access is half the work! and the current study clearly consolidate this notion.

Carsten Reidies Bjarkam

Aalborg, Denmark

This article is part of the Topical Collection on Neurosurgical Anatomy

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Gagliardi, F., Piloni, M., Snider, S. et al. Impact of C-shaped skin incision on surgical operability in the retrosigmoid approach: when a good start is half of the job. Acta Neurochir 163, 2155–2163 (2021). https://doi.org/10.1007/s00701-021-04889-x

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  • DOI: https://doi.org/10.1007/s00701-021-04889-x

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