title: A method of posterior fossa dural incision to minimize hemorrhage from the occipital sinus: the "mosquito" method.
abstract: OBJECTIVE
  The posterior fossa dural opening requires the ligation of the occipital sinus to gain successful exposure. However, there could be a prominent occipital sinus which is functioning as the main drainage route and is harboring the risk of unpredictable massive hemorrhage during the dural opening. We introduce a safe method of posterior fossa dural incision to minimize hemorrhage from the occipital sinus using four curved hemostat clamps.
  
  
  METHODS
  For the dural incision at the midline part of the posterior cranial fossa, we used four curved hemostat clamps to occlude the prominent occipital sinus: one pair of clamps at the proximal part and the other pair at the distal part to occlude the occipital sinus. Dural incision was made between the two pairs of the curved hemostat clamps.
  
  
  RESULTS
  By clamping of the sinus, it allows observation of possible brain swelling after occlusion of the occipital sinus as well as minimizes hemorrhage during incision of the midline dura of the posterior fossa.
  
  
  CONCLUSIONS
  This method allows observation of brain swelling after occipital sinus occlusion and is an easy and safe incision of the midline dura minimizing hemorrhage in selected cases with a prominent occipital sinus.
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Hee Chang
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Ji Yeoun
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Seul Ki
authors.initials: SK
authors.lastname: Ryu
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Jang Mi
authors.initials: JM
authors.lastname: Lim
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Sangjoon
authors.initials: S
authors.lastname: Chong
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Phi
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. kcwang@snu.ac.kr.
authors.forename: Kyu-Chang
authors.initials: KC
authors.lastname: Wang
mesh_terms: D002543:Cerebral Hemorrhage / Q000517:prevention & control*; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods*; D004388:Dura Mater / Q000601:surgery; D006801:Humans; D013525:Surgical Instruments
keywords: Durotomy; Occipital sinus; Suboccipital craniotomy