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Retromastoid Craniotomy

Retromastoid Craniotomy for Acoustic Tumor General Considerations As in the case with the pterional craniotomy for supratentorial parasellar lesions, the retromastoid craniotomy is the workhorse of infratentorial approaches for reaching the cerebellopontine (CP) angle and ventrolateral brainstem.  Based on the definition of the extended pterional approach, lateral sphenoid wing is resected to the level of the superior orbital fissure and the roof of the orbit is flattened to provide an unobstructed operative corridor toward the subfrontal and parasellar area.  Similarly, I define the extended retromastoid approach as a modification of the standard retromastoid craniotomy that includes partial removal of the bone over the sigmoid sinus.  This “untethering” of the sigmoid sinus allows its lateral mobilization using retraction sutures after dural opening. This maneuver expands the lateral operative trajectory toward the CP angle while reducing the retraction on the cerebellar hemisp...

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