Retrosigmoid Approach: Investigating the Role of a C-Shaped Skin Incision and Muscle Flaps in Improving Functional Outcome and Reducing Postoperative Pain.

Abstract

To investigate the impact on functional outcome and postoperative pain of a modified C-shaped skin incision and muscle flaps in patients undergoing mini-craniotomy via a retrosigmoid approach (mCRSA). Enrolled patients were studied prospectively and divided/assigned to group A, with a standard straight/lazy S-shaped incision, or to group B, with a modified C-shaped incision. The latter consisted of a 4-cm C-shaped skin incision with medial convexity (placed 8 cm lateral to the external occipital protuberance, with the lower edge terminating 1.5-2 cm above the mastoid tip), followed, after subperiosteal dissection, by superior and inferior reflection of the muscle flaps by stitches. Eighty patients, 40 in each group, were enrolled in the study. The overall complication rate was significantly lower (P < 0.0001) in group B. The incidence of cerebrospinal fluid (CSF) leak was 4% in group B versus 12% in group A; furthermore, no wound infection was recorded in group B, whereas 2 cases (4%) occurred in group A. Overall, group B patients had a higher satisfaction rate (P= 0.0002), and the prevalence of postoperative retroauricular pain/neck discomfort was significantly higher (P= 0.0002) in group A (30% vs. 0%). The modified C-shaped skin incision and muscle flaps technique provides superior surgical exposure with advantages over the standard straight/lazy S-shaped incision including no need for a self-retaining retractor and a shorter working distance. This study supports the research hypothesis that the landmarks-based design of the C-shaped incision may decrease the risk of occipital muscle/cutaneous nerve injuries and CSF leak, resulting in better functional outcomes.