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
