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, as well as wound healing are all common complications following traditional suboccipital midline incision. Herein, we present a novel incision for approaching posterior fossa pathologies. The incision is shaped like a question mark and makes a musculofascial flap supplied by the occipital artery on top as well as a wide area for craniotomy. In our technique, the dura is also incised in a question mark-shaped manner. The new incision was used to operate on three patients who had masses in the posterior fossa. Following surgeries, none of the patients experienced any adverse events such as CSF leak, wound complications, severe suboccipital pain, and neck instability. This new incision not only facilitates approaching pathologies in the posterior fossa by providing wider exposure but also enables us to perform watertight dural closure, which reduces CSF leak. Furthermore, as the muscular incision provides a sufficient area for craniotomy, muscular retraction can be minimized to reduce post-operative pain. Moreover, unlike the midline avascular incision, the flap is well supplied by the occipital artery, which facilitates the healing procedure.