Trautmann-focused mastoidectomy for a simple, safe presigmoid approach: technical note

• Published in: Journal of neurosurgery Vol. 134; no. 3; p. 843
• Main Authors: Tanahashi, Kuniaki, Uda, Kenji, Araki, Yoshio, Takeuchi, Kazuhito, Choo, Jungsu, Chalise, Lushun, Motomura, Kazuya, Ohka, Fumiharu, Wakabayashi, Toshihiko, Natsume, Atsushi
• Format: Journal Article
• Language: English
• Published: United States 01.03.2021
• Subjects: Abducens Nerve Diseases - surgery; Adult; Aged; Cadaver; Cerebellar Neoplasms - surgery; Cerebellopontine Angle - surgery; Ear, Inner - surgery; Epidermal Cyst - surgery; Female; Humans; Intracranial Arteriovenous Malformations - surgery; Magnetic Resonance Imaging; Mastoid - surgery; Mastoidectomy - methods; Neurosurgical Procedures - methods; Patient Positioning; Skull Base - anatomy & histology; Skull Base - surgery; Vertebrobasilar Insufficiency - surgery; surgical technique; vertebrobasilar artery aneurysm; brainstem cavernous malformation; posterior petrosal approach; presigmoid retrolabyrinthine approach; skull base; cerebellopontine angle tumor; mastoidectomy
• DOI: 10.3171/2020.1.jns193179

The presigmoid approach (PSA) is selected to obtain more lateral access to cerebellopontine angle tumors, brainstem cavernous malformations, or vertebrobasilar artery aneurysms than the standard retrosigmoid approach. However, mastoidectomy for the PSA can be considered time-consuming and to carry a higher risk of complications due to the anatomical complexity of the region. The authors established a method of minimized mastoidectomy focused on exposing Trautmann's triangle as the corridor for the PSA while maximizing procedural simplicity and safety and maintaining a sufficient operative view. The authors present their method of minimized mastoidectomy in a cadaver dissection and operative cases, showing potential as a useful option for the PSA.