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Comparison of the Retrosigmoid Approach and the Minimal Mastoidectomy, Retrolabyrinthine, Translabyrinthine, and Transcochlear Approach Modifications of the Presigmoid Approach

Surgical Correlation


A, Retrosigmoid approach. The left cerebellum has been elevated to expose the cranial nerves V through XI in the cerebellopontine angle. The illustrations from each step are to be compared with the views from the other modifications of the approach. B, The facial and vestibulocochlear nerves and the flocculus have been retracted to expose the side of the basilar artery. C, For the minimal mastoidectomy, only enough bone is removed in front of the sigmoid sinus to open the presigmoid dura and divide the superior petrosal sinus and tentorium. D, The presigmoid dura has been opened and the sigmoid sinus has been retracted posteriorly. The view is approximately the same as that seen with the retrosigmoid exposure. The retrosigmoid approach provides a better view of the nerves entering the jugular foramen. (Images courtesy of AL Rhoton, Jr.)