Modified Dandy Stair-Step Incision for Retrosigmoid Craniotomies to Reduce Postoperative Complications in Skull Base Surgery

Abstract

Background

Retrosigmoid craniotomies are prone to postoperative complications, including wound complications, necessitating careful surgical closure. A modified Dandy stair-step technique was developed to address these concerns by ensuring a watertight seal, preserving the blood supply, sparing the muscles, and approximating the wound layers precisely under a cranial flap.

Methods

A retrospective chart review was conducted on patients undergoing retrosigmoid craniotomies at a single institution from 2019 onward. Patients with prior craniotomies or less than 1 month of follow-up were excluded.

Results

Among 73 patients, 29 (39.7%) underwent the modified Dandy technique. Baseline characteristics were similar between the two groups, with 41 of them being female (56.2%), the median age being 59 (interquartile range [IQR]: 50–67), and 44 having never smoked (60.3%). The most common indications for surgery were vestibular schwannomas (53.4%), meningiomas (24.7%), and metastatic lesions (15.1%), while the rest were other lesions (6.8%). In the modified and control groups, the follow-up duration was 8.9 months (IQR: 5–10.6) and 15.9 months (IQR: 8–23.9; p = 0.01). Wound complications occurred in 3.4% of the modified group (i.e., superficial wound erythema), compared to 15.9% in the control group (p = 0.02). These complications resulted in three reoperations (6.8%; p = 0.32) and seven readmissions (15.9%) in the control group (p = 0.03). Three patients in the control group (6.8%) had multiple complications, one of whom required multiple reoperations for persistent pseudo-meningocele. Notably, all complications except one occurred within 30 days.

Discussion

This study suggests that the modified technique may reduce wound-related complications following retrosigmoid craniotomies, though further research is required to confirm its efficacy.

Keywords

complex wound - layered closing - precranial flap - retrosigmoid craniotomy - wound complications

Publication History

Received: 29 April 2025

Accepted: 15 September 2025

Article published online:
30 September 2025

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