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CC BY 4.0 · J Neurol Surg B Skull Base 2024; 85(S 02): e117-e130
DOI: 10.1055/a-2222-0184
Original Article

Skull Base Repair following Resection of Vestibular Schwannoma: A Systematic Review (Part 1: The Retrosigmoid 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
› Author Affiliations
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

Objective Despite advances in skull-base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a common complication following retrosigmoid (RS) vestibular schwannoma (VS) surgery. We aimed to review and classify the available strategies used to prevent CSF leaks following RS VS surgery.

Methods A systematic review, including studies of adults undergoing RS VS surgery since 2000, was conducted. Repair protocols were synthesized into a narrative summary, and a taxonomic classification of techniques and materials was produced. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were described.

Results All 42 studies were case series, of which 34 were retrospective, and eight were prospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A repair taxonomy was produced considering seven distinct stages to CSF leak prevention, including intraoperative approaches to the dura, internal auditory canal (IAC), air cells, RS bony defect, extracranial soft tissue, postoperative dressings, and CSF diversion. Notably, there was significant heterogeneity among institutions, particularly in the dural and IAC stages. The median postoperative incidence of CSF leaks was 6.3% (IQR: 1.3–8.44%).

Conclusions The intraoperative strategies used to prevent CSF leaks during RS VS surgery vary between and within institutions. As a result of this heterogeneity and inconsistent reporting of CSF leak predictive factors, a meaningful comparative analysis of repair protocols was not feasible. Instead, we propose the development of a prospective multicenter observational evaluation designed to accurately capture a comprehensive dataset of potential CSF risk factors, including all stages of the operative repair protocol.

Keywords

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

* Equal senior authorship.


Supplementary Material



Publication History

Received: 05 September 2023

Accepted: 25 November 2023

Accepted Manuscript online:
04 December 2023

Article published online:
22 January 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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