Gagliardi Filippo, Piloni Martina, Snider Silvia, Roncelli Francesca, Pompeo Edoardo, Caputy Anthony J, Mortini Pietro
Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
Department of Neurological Surgery, The George Washington University, Washington, DC, USA.
Acta Neurochir (Wien). 2021 Aug;163(8):2155-2163. doi: 10.1007/s00701-021-04889-x. Epub 2021 Jun 7.
The retrosigmoid approach (RSA) is one of the routes of choice to approach tumors and vascular lesions of the cerebellopontine angle. Among different types of skin incisions and soft tissue dissection techniques, the most widely used variants comprise the straight/lazy S-shaped and the C-shaped incisions. Several reports discuss advantages in terms of functional and clinical outcomes of the C-shaped incision, but scientific considerations about the critical impact of this kind of incision on surgical operability are still extremely limited.
Authors comparatively analyze the advantage provided by C-shaped incision in RSA in terms of anatomic exposure and surgical operability, compared with straight/lazy S-shaped one.
A comparative microanatomical laboratory investigation was conducted. The operability score (OS) was applied for quantitative analysis of surgical operability.
C-shaped incision, providing a significant reduction of the overall working distance (-13%) together with an overall increase of the maneuverability area (+ 204.9%), did improve the conizing effect on the surgical corridor. It optimized overall maneuverability of surgical instruments, in terms of angle of attack (+ 27.7%), as well as maneuverability arc (+ 122%), on the entire surgical field. C-shaped incision ensured good operability on all surgical targets (OS ranging from 2 to 3), most significantly improving surgical maneuverability at the porus trigeminus and internal acoustic meatus.
C-shaped incision in the RSA significantly improves anatomic exposure and surgical operability as compared with straight/lazy S-shaped incision.
乙状窦后入路（RSA）是处理桥小脑角肿瘤和血管病变的常用入路之一。在不同类型的皮肤切口和软组织分离技术中，应用最广泛的变体包括直形/改良S形和C形切口。有几份报告讨论了C形切口在功能和临床结果方面的优势，但关于这种切口对手术可操作性的关键影响的科学考量仍然极为有限。
作者将RSA中C形切口与直形/改良S形切口在解剖暴露和手术可操作性方面的优势进行比较分析。
进行了一项比较性显微解剖实验室研究。应用手术可操作性评分（OS）对手术可操作性进行定量分析。
C形切口显著缩短了整体工作距离（-13%），同时显著增加了可操作区域（+204.9%），确实改善了手术通道的锥切效果。在整个手术区域，它在攻击角度（+27.7%）以及操作弧度（+122%）方面优化了手术器械的整体可操作性。C形切口确保了对所有手术靶点的良好可操作性（OS范围为2至3），在三叉神经孔和内耳道处最显著地提高了手术可操作性。
与直形/改良S形切口相比，RSA中的C形切口显著改善了解剖暴露和手术可操作性。
