Micro-Doppler for venous sinus localization in approaches to the cerebello-pontine angle.

Abstract

Main anatomical landmarks of retrosigmoid craniotomy are transverse sinus (TS), sigmoid sinus (SS), and the confluence of both. Anatomical references and guidance based on preoperative imaging studies are less reliable in the posterior fossa than in the supratentorial region. Simple intraoperative real-time guidance methods are in demand to increase safety. This manuscript describes the localization of TS, SS, and TS-SS junction by audio blood flow detection with a micro-Doppler system. This is an additional technique to increase safety during craniotomy and dura opening, widening the surgical corridor to secure margins without carrying risks nor increase surgical time.