• Gökberk Erol, Neslihan Çavuşoğlu, Umut Tan Sevgi, Semih Fidan, Çağrı Canbolat, Yücel Doğruel, Sabino Luzzi, Aaron A Cohen Gadol, and Abuzer Güngor.
• Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey.
• World Neurosurg. 2024 Apr 1; 184: e121e128e121-e128.

BackgroundDurotomies, traditionally used during the midline suboccipital approach, involve sacrificing the occipital sinus (OS) with consequent shrinking of the dura, risk of venous complications, difficulty performing watertight closure, and a higher rate of postoperative cerebrospinal fluid (CSF) leaks. The present technical note describes the OS-sparing linear paramedian dural incision, which leads to a decrease in the risk of complications during the median suboccipital approach in our case series.MethodsThe OS-sparing linear incision technique involves a dural incision placed 1 cm lateral to the OS. The angle of view of the microscope is frequently changed to overcome the narrowed exposure of the linear durotomy. Copious irrigation with saline prevents drying of the dura. A running watertight closure of the dura is performed. The overall results of 5 cases are reviewed.ResultsThe cases were 3 tumors and 2 cavernomas. The OS was preserved in all 5, and no duraplasty was needed. The average dura closure time was 16.8 minutes. No CSF leak occurred, and no wound complications were observed. A gross total resection of the lesion was achieved in all the patients. The mean follow-up was 10.2 months, and there were no late complications related to the dura closure.ConclusionsIn comparison to the types of durotomies conventionally used for the midline suboccipital approach, the OS-sparing linear paramedian dural incision entails lower risks of bleeding, venous complications, CSF leaks, and infections by avoiding duraplasty. Validation of this technical note on a larger patient cohort is needed.Copyright © 2024 Elsevier Inc. All rights reserved.

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