J Neurol Surg B Skull Base 2022; 83(S 02): e324-e335
DOI: 10.1055/s-0041-1729177
Original Article

History, Variations, and Extensions of the Retrosigmoid Approach: Anatomical and Literature Review

Jaafar Basma
1   Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States
2   Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
,
Christos Anagnostopoulos
2   Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
,
Andrei Tudose
2   Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
,
Mikhail Harty
2   Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
,
L. Madison Michael II
1   Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States
3   Semmes-Murphey Clinic, Memphis, Tennessee, United States
,
Mario Teo
2   Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
,
David G. Porter
2   Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
› Author Affiliations

Abstract

The retrosigmoid approach is the workhorse for posterior fossa surgery. It gives a versatile corridor to tackle different types of lesions in and around the cerebellopontine angle. The term “extended” has been used interchangeably in the literature, sometimes creating confusion. Our aim was to present a thorough analysis of the approach, its history, and its potential extensions. Releasing cerebrospinal fluid from the subarachnoid spaces and meticulous microsurgical techniques allowed for the emergence of the retrosigmoid approach as a unilateral variation of the traditional suboccipital approach. Anatomical landmarks are helpful in localizing the venous sinuses and planning the craniotomy, and Rhoton's rule of three is the key to unlock difficult neurovascular relationships. Extensions of the approach include, among others, the transmastoid, supracerebellar, far-lateral, jugular foramen, and perimeatal approaches. The retrosigmoid approach applies to a broad range of pathologies and, with its extensions, can provide adequate exposure, obviating the need for extensive and complicated approaches.



Publication History

Received: 14 October 2020

Accepted: 27 February 2021

Article published online:
05 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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