Retrosigmoid Intradural Suprameatal Approach: 2-Dimensional Operative Video

Area of Science:

• Neurosurgery
• Surgical Anatomy
• Skull Base Surgery

Background:

• The retrosigmoid intradural suprameatal approach is primarily used for tumors in the cerebellopontine angle, Meckel cave, and supratentorial regions.
• Meningiomas and schwannomas are the most common tumors addressed with this technique.
• This surgical corridor was established in 1982.

Purpose of the Study:

• To describe the indications, anatomical considerations, procedural steps, and potential complications of the retrosigmoid intradural suprameatal approach.
• To highlight the importance of preoperative planning and anatomical knowledge for successful tumor resection.

Main Methods:

• The approach involves a suboccipital retrosigmoid craniectomy in a semisitting position.
• Tumor debulking is followed by drilling of the suprameatal tubercle towards the petrous apex, tailored to each patient.
• Careful dissection and avoidance of damage to cranial nerves and vascular structures are crucial.

Main Results:

• The approach provides access to tumors extending from the cerebellopontine angle to supratentorial and infratentorial regions.
• Bone drilling is adjusted based on tumor extension, with tentorial or foramen magnum opening as necessary.
• Successful tumor removal while preserving neural and vascular structures is the primary goal.

Conclusions:

• The retrosigmoid intradural suprameatal approach is a versatile technique for managing complex cerebellopontine angle tumors.
• Meticulous surgical technique and thorough understanding of surgical anatomy are essential to minimize complications.
• Variants of the approach allow for tailored treatment of tumors with extensive intracranial or spinal extensions.