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Introduction Hematoma due to dural-sinus damage is a known complication when introducing burr holes in open transcranial surgery. Our objective was to identify safe areas to avoid dural-sinus damage based on anatomical landmarks in translabyrinthine and retrosigmoid open surgical approaches where neuronavigation facilities are not available. Methods A descriptive anatomical study was conducted on adult skulls. Distances to transverse and sigmoid sinuses on either side were measured using fixed anatomical landmarks: asterion, inion, margins of suprameatal triangle and superior nuchal line. Measurements were standardized according to the cranial indices (cranial index=anteroposterior diameter/transverse diameter) of each skull. Results Thirty-two adult skulls (male:female=22:10) were studied. Mean cranial index, width of transverse and sigmoid sinuses were 0.785±0.045, 9.1±2.3mm and 9.7±1.2mm respectively. Mean vertical distances from asterion and inion to the transverse sinus were 1.1±3.4mm and 14.7±5.9mm respectively. Posterior border of the sigmoid sinus was located 14.7±5.9mm, and 59.9±7.4mm anterior to asterion and inion respectively. t-tests did not show significant differences of these distances on either sides (p>.05). Pearson's correlations were insignificant between the measurements and the cranial indices (p>.05). Measurements from the suprameatal triangle to the dural-sinuses had the minimum variance. In >95% of the times the sigmoid sinus was located ≤23 mm posterior and ≤7 mm superior to the suprameatal triangle. Discussion and conclusions Suprameatal triangle was a consistent surface landmark to locate dural-sinuses. Dural-sinus damage could be avoided in 95% of the times by placing burr hole at least 7mm superior and 23 mm posterior to the suprameatal triangle.

Anatomical landmarks to locate the junction between transverse and sigmoid sinuses in translabyrinthine and retrosigmoid open surgical approaches