• Brandon D Liebelt, Meng Huang, and Gavin W Britz.
• Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, USA.
• World Neurosurg. 2018 May 1; 113: e88-e92.

BackgroundThe retrosigmoid approach is broadly applicable to many posterior fossa procedures. However, cerebellar retraction is often necessary for lesions in the cerebellopontine angle, which can lead to complications. An extended retrosigmoid approach skeletonizes the sigmoid sinus and allows a wider corridor with less retraction. This study investigated the differences in retraction pressure between the retrosigmoid and extended retrosigmoid approach in a cadaveric model.MethodsAnatomic dissection of 2 cadaveric heads was performed for comparison of surgical approaches. Bilateral measurements were obtained on each head, providing 4 sets of data. Retrosigmoid craniotomy was first performed with recording of retraction pressure necessary for 1.5-cm exposure. The exposure was then expanded to an extended retrosigmoid approach, and retraction pressures were recorded.ResultsMean retraction pressure in cadaver 1 for retrosigmoid and extended retrosigmoid approaches was 20.25 ± 5.9 mm Hg and 10.25 ± 3.8 mm Hg, respectively; in cadaver 2, values were 11.75 ± 3.1 mm Hg and 4.75 ± 1.8 mm Hg, respectively. This corresponded to a mean relative reduction in retraction pressure of 49.4% in cadaver 1 and 59.6% in cadaver 2 by using the extended retrosigmoid approach. Retraction pressures were also significantly less (P < 0.05) for the extended retrosigmoid group when comparing all surgical approaches (N = 4).ConclusionsThe extended retrosigmoid approach gains better visualization with reduced brain retraction. In our study, cerebellar retraction pressures were greatly reduced when using the extended retrosigmoid approach in a cadaveric model.Copyright © 2018. Published by Elsevier Inc.

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