A Novel Skin Incision for Posterior Fossa Midline and Paramedian Lesions; A Technical Note and Case Series

Approaching posterior fossa pathologies is fairly challenging. Poor exposure, Cerebrospinal Fluid (CSF) leak following surgery, post-operative suboccipital and neck pain, and wound healing are common challenges following traditional suboccipital midline incision. Herein, we present a new incision for approaching posterior fossa pathologies. The incision is shaped like a question mark and makes a musculofascial flap supplied by occipital artery on top of providing a wide area for craniotomy. In our technique, the dura is also incised in a question mark shaped manner. Three patients with masses in posterior fossa were operated with the new incision. Following surgeries, there were no adverse events including CSF leak, wound complications, severe suboccipital pain and neck instability in any of the patients. This new incision not only facilitates approaching to pathologies in posterior fossa with providing wider exposure, but also enables us for watertight Dural closure which decreases CSF leak. Also, as the muscular incision provides a sufficient area for craniotomy, muscular retraction can be minimized to avoid post-operative pain. Moreover, as opposed to the midline avascular incision, the flap is well supplied by occipital artery which facilitates the healing procedure.