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CC BY 4.0 · J Neurol Surg B Skull Base 2024; 85(S 02): e131-e144
DOI: 10.1055/a-2222-0016
Original Article

Skull Base Repair following Resection of Vestibular Schwannoma: A Systematic Review (Part 2: The Translabyrinthine Approach)

Joachim Starup-Hansen 
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Simon C. Williams
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
3   Department of Neurosurgery, The Royal London Hospital, London United Kingdom
,
Alexandra Valetopoulou
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Danyal Z. Khan
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Hugo Layard Horsfall 
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Jigishaa Moudgil-Joshi
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Oliver Burton
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Hala Kanona
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
5   The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
,
Shakeel R. Saeed
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
5   The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
6   University College London Ear Institute, London, United Kingdom
,
William Muirhead
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Hani J. Marcus   *
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Patrick Grover   *
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
› Institutsangaben
Funding This study was funded by Wellcome/EPSRC Centre for Interventional and Surgical Sciences.Wellcome (203145Z/16/Z), EPSRC (NS/A000050/1).
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Abstract

Objectives Despite advances in skull base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a relatively common complication after translabyrinthine (TL) vestibular schwannoma (VS) surgery. We conducted a systematic review to synthesize the repair techniques and materials used in TL VS surgery to prevent CSF leaks.

Design A systematic review of studies published since 2000 reporting techniques to prevent CSF leaks during adult TL VS surgery was conducted. A narrative synthesis of primary repair protocols was produced, and a taxonomy was established. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were extracted.

Results All 43 studies were case series, and 39 were retrospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A taxonomy was produced, classifying repairs into seven distinct stages, including approaches to the dura, middle ear cleft, air cells, TL bony defect, extra-cranial soft tissue, postoperative dressings, and CSF diversion. The median postoperative incidence of CSF leaks was 6% (interquartile range: 0–10%).

Conclusions This systematic review reveals substantial inter-institutional heterogeneity in intraoperative strategies to prevent CSF leaks following TL VS surgery. However, comparing these techniques is challenging due to the multiple predictive factors for CSF leaks and their inconsistent reporting. We propose a taxonomy of seven stages to classify operative techniques and materials aimed at preventing CSF leaks. We recommend that future evaluations should adopt a prospective approach encompassing data collection strategies that considers all operative stages described by our taxonomy.

Keywords

vestibular schwannoma - CSF leak - skull base repair - neurosurgery - ear nose and throat - translabyrinthine approach

* Equal senior authorship.


Supplementary Material



Publikationsverlauf

Eingereicht: 05. September 2023

Angenommen: 25. November 2023

Accepted Manuscript online:
04. Dezember 2023

Artikel online veröffentlicht:
22. Januar 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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