Introduction: Retrosigmoid craniotomies require careful wound closures, as they can more readily develop CSF leaks and other associated wound complications. Thus, it is essential to ensure watertight closure, preserve the blood supply, and precisely approximate the wound layers. The modified dandy technique was developed to address these factors.
Methods: A retrospective chart review was conducted on patients undergoing retrosigmoid craniotomies at a single institution starting in 2019. Patients with prior craniotomies and less than one month of follow-up were excluded.
Results: Of 85 operations in 83 patients, 29 (34.1%) underwent the modified technique. Baseline characteristics were similar between the two groups, with 50 of them being female (58.8%), the median age being 59 (IQR: 49-68), and 50 having never smoked (58.8%). The incidences of diabetes, hypertension, coronary artery disease, and peripheral artery disease were similar between groups. 29 patients underwent craniotomy for microvascular decompression (34.9%), 29 patients for resection of a vestibular schwannoma (34.9%), thirteen for resection of a meningioma (15.3%), and the rest for resection of other lesions (16.5%). In the modified and control groups, the follow-up duration was 8.9 months (IQR: 5-10.6) and 9.7 months (IQR: 3.2-20) (p=0.14). There was only one complication (3.4%) in the modified group, superficial wound erythema, compared with sixteen (28.6%) in the control group (p < 0.01). These complications resulted in six reoperations (10.7%) (p=0.05) and fourteen readmissions (25%) for complication management (p < 0.01). Three patients (5.4%) in the control group had multiple complications, one of whom required multiple reoperations for persistent pseudo-meningocele.
Conclusion : Despite the limited size of this study, the modified dandy technique is promising in curtailing wound healing complications in retrosigmoid craniotomies. More studies are needed to further validate the efficacy of the technique.
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