Crescent posterior fossa durotomy for occipito-marginal venous sinus preservation: A pilot study

Abstract

The standard approach of midline suboccipital craniectomy entails sacrifice of the Occipito-marginal sinus. We have attempted to preserve this venous channel by using a durotomy technique which preserves this system. In a pilot study initiative, two groups of patients using this technique versus the standard approach, were compared in terms of per and post operative benefits, morbidity and complications. The literature with reference to the anatomy and venous flow dynamics of the occipital and marginal sinuses and their significance has been reviewed. Similarly, literature regarding dural closure technique with reference to postoperative complications has also been reviewed. In this novel approach, the dura is opened as a crescent to avoid damage to the occipital sinus. This technique was compared with the standard midline dural opening technique by random usage of both techniques in 24 patients. The 'crescent' approach has been found to reduce the need for duroplasty, with comfortable primary closure and to reduce the risk of postoperative pseudomeningocele. This is a novel dural opening technique which attempts to preserve the normal venous flow physiology. In essence it helps in increased primary dural closures and reduction of Pseudomeningiocele/CSF leak as well as blood loss and venous hypertension.