Minimizing tissue damage through a modified muscle-sparing technique of retro-sigmoid exposure using linear incision

Background: Conventional retrosigmoid craniotomy involves cutting of suboccipital muscles and neurovasculature, often leading to chronic postoperative pain and neck discomfort. We evaluated a modified, muscle-sparing linear incision technique designed to preserve these structures. Methods: This observational cohort study compared 34 cases using the muscle-sparing technique (Group A) with 34 cases using conventional muscle cutting techniques (Group B). In Group A, a linear incision was followed by sharp subfascial dissection, allowing the suboccipital muscle group and occipital neurovascular bundle to be reflected inferiorly as a single subperiosteal unit without muscular incision. Following dural closure, the muscles were re-anchored to the fascial layer to restore normal anatomy and provide a buttressing effect. Patients were followed for 12 months to monitor localized pain, edema, pseudomeningocele, and headache. Results: The modified technique provided adequate posterior fossa access. Demographic data analysis showed no significant differences in age and gender. Group A demonstrated significantly shorter incision lengths (4.93 ± 0.36 cm vs. 10.65 ± 0.47 cm) and reduced blood loss (16.71 ± 1.68 mL vs. 71.21 ± 5.27 mL) ( P < 0.001). Opening and closing times were also significantly faster in Group A ( P < 0.001). While Group A had fewer complications (2.9% vs. 14.7%), the difference was not statistically significant ( P = 0.197). At 12 months, Group A reported no chronic neck discomfort. Conclusion: The muscle-sparing linear incision is a safe, efficient technique that minimizes tissue destruction and reduces operative time. Preservation of the suboccipital neurovascular bundle and restoration of anatomical layers significantly reduce postoperative morbidity.