Reconstruction after Retrosigmoid Approaches Using Autologous Fat Graft-Assisted Medpor Titan Cranioplasty: Assessment of Postoperative Cerebrospinal Fluid Leaks and Headaches in 46 Cases

Object: Postoperative cerebrospinal fluid (CSF) leaks and headaches remain potential complications after retrosigmoid approaches for lesions in the posterior fossa and cerebellopontine angle. The authors describe a simple repair technique with an autologous fat graft-assisted Medpor Titan cranioplasty, and investigate the incidence of postoperative CSF leaks and headaches using this technique.

Methods: A retrospective chart review was conducted on all cases (n = 46) of retrosigmoid craniectomy from September 2009 to May 2013 that underwent fat graft-assisted cranioplasty. After obtaining a watertight dural closure and sealing off any visible mastoid air cells with bone wax, an autologous fat graft was placed over the dural suture line and up against the waxed-off air cells. The fat graft filled the retrosigmoid cranial defect and was then bolstered with a Medpor Titan (titanium mesh embedded in porous polyethylene) cranioplasty. A postoperative mastoid pressure dressing was applied for 48 hours and prophylactic lumbar drainage was not used. Factors examined in this study included postoperative CSF leak (incisional, rhinorrhea, otorrhea), pseudomeningocele formation, postoperative headache, length of hospital stay, and length of follow-up.

Results: No patients developed postoperative CSF leaks (0%), pseudomeningoceles (0%) or new-onset postoperative headaches (0%) with the described repair technique. There were no cases of graft site morbidity such as hematoma or wound infection. Mean duration of postoperative hospital stay was 3.8 days (range 2–10 days). Mean postoperative follow-up was 11.4 months (range 1.2–41.1 months).

Conclusions: Our simple multi-layer repair technique with a fat graft-assisted Medpor Titan cranioplasty appears effective in preventing postoperative CSF leaks and new-onset postoperative headaches after retrosigmoid approaches. Postoperative lumbar drainage may not be necessary.