Skull Base Reconstruction after Far Lateral Transcondylar Approaches Using Autologous Fat Graft-Assisted Medpor Titan Cranioplasty: Surgical Technique and Nuances
Object: One of the most common complications arising after far lateral transcondylar surgery for lesions in the ventral foramen magnum and the craniovertebral junction is cerebrospinal fluid (CSF) leakage. A simple reconstruction technique to prevent postoperative CSF leakage is described using an autologous fat graft-assisted Medpor Titan cranioplasty.
Methods: A retrospective chart review was performed on 12 consecutive patients who underwent a far lateral transcondylar approach with the following repair technique. 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. Fat was also used to fill anatomic dead space in the craniectomy defect and the cervical musculature. Care was taken not to overpack the fat so as to avoid compression of the cerebellum and cervicomedullary junction. The fat graft 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 postoperative 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: There were no cases of postoperative CSF leakage (0%), pseudomeningoceles (0%), or headaches (0%) following our described repair technique. Mean follow-up was 13 months (range 1–39 months). Excellent cosmetic outcome was achieved in all patients.
Conclusions: Our repair technique using autologous fat graft-assisted Medpor Titan cranioplasty appears effective in preventing postoperative CSF leakage and headache after far lateral transcondylar approaches.