A review of skin incisions and scalp flaps for the retromastoid approach and description of an alternative technique

BACKGROUND: The retromastoid approach has been effective in exposing the cerebellopontine angle for resection of a variety of lesions, including vestibular schwannomas and decompression of cranial nerves. The following incisions and their variations have been most commonly used for the retromastoid approach: linear (and its variations, such as “lazy S-shaped”) and “C-shaped” incision. METHODS: Herein, we describe a curvilinear incision and compare its advantages and disadvantages with the other previously described incisions based on the senior author's experience with 120 retromastoid operations. RESULTS: The senior author has used the curvilinear incision for the last 70 of 120 patients who underwent retromastoid operations. Of these, one patient encountered postoperative cerebrospinal fluid (CSF) leakage through the incision, requiring a repeat operative wound revision, and one patient suffered from a soft asymptomatic pseudomeningocele. Among the initial 50 patients who underwent a linear incision, one patient suffered from a CSF leakage managed with local wound care and another patient required a repeat operation for a tense pseudomeningocele. No wound breakdown or infection was encountered in either group. CONCLUSIONS: The curvilinear incision is simple and efficient and may provide a shorter working distance and protect the suboccipital muscles and associated neurovascular bundle.