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Chibbaro S, Cebula H, Zaed I, Gubian A, Todeschi J, Scibilia A, Nannavecchia B, Scheer L, Bozzi MT, Mahoudeau P, Coca A, Signorelli F, Djennaoui I, Debry C, Ganau M. A Laboratory Investigation on a Tailored Skin and Muscle Flap Variant for the Retrosigmoid Approach. Skull Base Surg 2022; 83:e438-e442. [DOI: 10.1055/s-0041-1730890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
Abstract
Introduction An anatomical study was conducted to test a modified C-shaped flap designed for patients undergoing a keyhole approach and/or minicraniotomy for retrosigmoid approach (KRSA).
Materials and Methods Ten heads specimens were used. The surgical technique investigated was based on a 4-cm C-shaped skin incision with medial convexity (placed 8 cm laterally to the external occipital protuberance, with the lower edge terminating 1.5 to 2 cm above the mastoid tip), which followed by careful subperiosteal dissection and completed by reflecting and securing the skin flap layer anteriorly and the muscle flaps superiorly and inferiorly by stitches. Anatomical findings, including depth of surgical corridor till to the cerebellopontine cistern (CPC) as well as the sparing of neurovascular structures, were evaluated in every specimen.
Results Twenty surgical approaches to CPC were conducted, resulting in a short working distance to the target (32 mm) without any need for a self-retaining retractor. In every specimen, the integrity of occipital muscles and cutaneous nerves was maintained, and a solid multilayer closure was always achieved. These data suggest that landmarks-based design of this C-shaped incision could be helpful in avoiding damages to the soft tissues encountered during KRSA.
Conclusion This modified approach provides a wide surgical corridor to access the CPC while ensuring the minimal invasiveness of the standard S-shaped incision. Compared with the latter, it preserves better the integrity of the surrounding soft tissues and appears less likely to cause any iatrogenic injury to occipital muscles and cutaneous nerves.
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Affiliation(s)
- Salvatore Chibbaro
- Division of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Helene Cebula
- Division of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Ismail Zaed
- Division of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Arthur Gubian
- Division of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Julien Todeschi
- Division of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Antonino Scibilia
- Division of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | | | - Louise Scheer
- Division of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Maria Teresa Bozzi
- Division of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Pierre Mahoudeau
- Division of ENT, Strasbourg University Hospital, Strasbourg, France
| | - Andres Coca
- Division of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | | | - Idir Djennaoui
- Division of ENT, Strasbourg University Hospital, Strasbourg, France
| | - Christian Debry
- Division of ENT, Strasbourg University Hospital, Strasbourg, France
| | - Mario Ganau
- Division of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
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