Cerebrospinal Fluid Leak after Microsurgical Surgery in Vestibular Schwannomas via Retrosigmoidal Craniotomy

Objective: Cerebrospinal fluid leak (CSF) is still a common complication in surgery of vestibular schwannoma (VS), increasing morbidity. Our study was performed to determine the incidences of CSF leaks after microsurgical removal of vestibular schwannoma via a retrosigmoidal approach with two different surgical closure techniques.

Methods: Between January 2003 and December 2009, microsurgical tumor resection using a suboccipital approach was performed in 81 patients. In 41 cases, the dural closure was done using a sandwich technique: Subdural closure with TissuFleece, respectively Spongostan, and after that, dural suture and epidural TachoSil were fixed on. In 40 cases, the dura was sealed epidurally with TachoSil after suture. In 65 cases, the posterior wall of the petrosus bone was drilled. The closure was performed using muscle and Fibrin glue. All patients had a minimal follow-up of 1 year.

Results: Seven patients (8.6%) developed a CSF fistula. Three patients (3.7%) underwent surgical procedure because of persisting CSF fistula, and in four cases (4.9%) spontaneous closure under lumbar drain was observed. Comparing the different techniques of dura sealing, we found three CSF leaks (7.3%) in 41 patients who underwent the sandwich technique, whereas there were four CSF leaks (10%) in 40 patients who underwent a single epidurally sealed dura closure (P = 0.69). No rhinorrhea or otorhinorrhea was observed. No intracranial infection or meningitis occurred.

Conclusion: Suture and occlusion of the dura is an important step for preventing CSF leak and postoperative infection. A comparison of the sandwich technique and single-layer dural sealing revealed no significant difference between the two procedures.