Explore the precision of modern neurosurgery with our latest deep dive into the Retrosigmoid Intradural Suprameatal Approach, a technique refining the boundaries of brain surgery, showcased in an illuminating 2-dimensional operative video.
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Retrosigmoid Intradural Suprameatal Approach: 2-Dimensional Operative Video.
Samii et al., Oper Neurosurg (Hagerstown) 2023
DOI: 10.1227/ons.0000000000001030
The retrosigmoid intradural suprameatal approach (RISA) is a surgical technique primarily used for removing tumors located in the cerebellopontine angle that extend to the Meckel cave and supratentorial regions, such as meningiomas and schwannomas. This approach, pioneered by the senior author in 1982, involves careful navigation around critical nervous structures (cranial nerves III-XII, cerebellum, brainstem) and vascular structures (various arteries, sinuses, and veins). The procedure starts with a suboccipital retrosigmoid craniectomy in a semisitting position, followed by tumor debulking. To access the tumor, bone drilling is performed at the suprameatal tubercle, with the extent of drilling customized for each patient.
What’s new: The RISA allows for tailored bone drilling to access tumors, with the potential for tentorium opening for lateral and dorsal supratentorial extensions, or foramen magnum opening and C1 hemilaminectomy for inferior extensions.
Importance: This approach minimizes damage to critical structures during tumor removal, which is crucial for patient safety and postoperative recovery.
Contribution to literature: The RISA provides a nuanced and adaptable surgical route for complex tumor locations, enhancing the neurosurgical repertoire for treating challenging cases.