Minimizing tissue damage through a modified muscle-sparing technique of retro-sigmoid exposure using linear incision

Conventional retrosigmoid craniotomy involves cutting of suboccipital muscles and neurovasculature, often leading to chronic postoperative pain and neck discomfort. We evaluated a modified, muscle-sparing linear incision technique designed to preserve these structures.

This observational cohort study compared 34 cases using the muscle-sparing technique (Group A) with 34 cases using conventional muscle cutting techniques (Group B). In Group A, a linear incision was followed by sharp subfascial dissection, allowing the suboccipital muscle group and occipital neurovascular bundle to be reflected inferiorly as a single subperiosteal unit without muscular incision. Following dural closure, the muscles were re-anchored to the fascial layer to restore normal anatomy and provide a buttressing effect. Patients were followed for 12 months to monitor localized pain, edema, pseudomeningocele, and headache.

The modified technique provided adequate posterior fossa access. Demographic data analysis showed no significant differences in age and gender. Group A demonstrated significantly shorter incision lengths (4.93 ± 0.36 cm vs. 10.65 ± 0.47 cm) and reduced blood loss (16.71 ± 1.68 mL vs. 71.21 ± 5.27 mL) (P < 0.001). Opening and closing times were also significantly faster in Group A (P < 0.001). While Group A had fewer complications (2.9% vs. 14.7%), the difference was not statistically significant (P = 0.197). At 12 months, Group A reported no chronic neck discomfort.

The muscle-sparing linear incision is a safe, efficient technique that minimizes tissue destruction and reduces operative time. Preservation of the suboccipital neurovascular bundle and restoration of anatomical layers significantly reduce postoperative morbidity.