Autologous Fascia Sling Technique for Dural Reconstruction Following Transtemporal Petrosectomy Approaches

Background: Reconstruction of presigmoid dural defects after transtemporal petrosectomy skull base approaches (translabyrinthine, retrolabyrinthine, partial labyrinthectomy, transpetrosal, and infratemporal fossa) is paramount to prevent CSF leakage.

Objective: This report describes our technique of dural reconstruction of presigmoid dural defects by creating a dural “sling” using an autologous fascia graft. The closure technique and postoperative cerebrospinal (CSF) leak rates are reported.

Methods: We reviewed 11 patients who underwent dural sling reconstruction using autologous fascia to prevent CSF leakage after a transmastoid transtemporal petrosectomy skull base approach. Presigmoid dural exposure was used as the surgical corridor to access the pathologies. In all of the surgeries, primary dural approximation was not possible. A dural sling was created by suturing an autologous fascia graft to the edges of the presigmoid dural defect using interrupted 4–0 Nurolon sutures. A monolayer of Surgicel was then placed over the suture line. The mastoid antrum and air cells were occluded with bone wax or bone cement. A fat graft was placed on top of the sling to occlude the mastoid defect, and care was taken not to compress the facial nerve. Fibrin glue was placed above the fat graft followed by another layer of Surgicel. The rest of the superficial mastoid cavity was filled with an additional layer of autologous fat graft. The fat graft was then bolstered by a titanium mesh plate imbedded in porous polyethylene to cover the mastoidectomy defect. Meticulous multilayered wound closure was then performed. Patients were evaluated for the presence of postoperative CSF leakage (including symptomatic pseudomeningocele requiring reoperation or shunting, incisional leak, rhinorrhea, otorrhea). Comparisons were made to an earlier cohort of 12 patients who underwent dural sling reconstruction using dural allograft material.

Results: There were no postoperative CSF leaks (0%) when an autologous fascia graft was used as the sling. However, 4 out of 12 (33%) CSF leaks were observed in patients whom a dural allograft sling was used.

Conclusion: An autologous fascial sling is a useful adjunct to standard dural repair techniques following transtemporal petrosectomy surgeries as a means of preventing postoperative CSF leaks.