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Puncture of Cerebellar Horizontal Fissure for Retrosigmoid Approach: A Prospective and Quantitative Analysis
Chang Kyu Park1, Sung Ho Lee1,2, Bong Arm Rhee1,2
1Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea.
Background:
Cerebrospinal fluid (CSF) drainage is important in retrosigmoid approached surgery; however, in some cases, it is not feasible due to cerebellar swelling.
Objective:
To introduce a method, puncture of the horizontal fissure of the cerebellum, which can reduce the cerebellum to easily obtain a good operative corridor and slowly drain CSF.
Methods:
Between January and December 2014, we estimated the precise location of the horizontal fissure in 56 patients who underwent surgery via a retrosigmoid approach. Then, we collected and analyzed CSF drained by puncturing the horizontal fissure. We investigated whether a good operative corridor was obtained with this method.
Results:
The location of the precise horizontal fissure was a mean of 3.97 mm caudal to transverse sinus and the mean amount of CSF drained in 56 patients was 50.4 mL. A good corridor was obtained in 46 (82.1%) of 56 patients without additional cistern puncture.
Conclusion:
The puncture of the horizontal fissure can be useful in retrosigmoid approach surgery. Moreover, inexperienced surgeons can use this method to effectively avoid injury of the cerebellum.
