Download PDF
CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2018; 79(04): 330-334
DOI: 10.1055/s-0037-1607455
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Primary Dural Closure for Retrosigmoid Approaches

Garrett T. Venable
1   College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Mallory L. Roberts
1   College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Ryan P. Lee
1   College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
L. Madison Michael II
2   Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
3   Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee, United States
› Author Affiliations
Further Information

Publication History

02 September 2016

10 July 2017

Publication Date:
10 November 2017 (online)

   Permissions and Reprints

Abstract

Object Primary closure of posterior fossa dura can be challenging, and postoperative cerebrospinal fluid (CSF) leaks continue to represent a common complication of the retrosigmoid approach. We describe a simple technique to allow for primary closure of the dura following retrosigmoid approaches. The incidence of CSF leaks using this method is reported.

Methods A retrospective chart review was conducted on all cases of retrosigmoid craniotomies performed by the senior surgeon from February 2009 to February 2015. The primary outcome was development of postoperative CSF leak or pseudomeningocele. Length of stay, lesion type, and other surgical complications were also reported.

Results Eighty-six patients underwent a retrosigmoid craniotomy during the study period. The most common indications for retrosigmoid craniotomy were microvascular decompression (58%) and tumor resection (36%). No allo- or autografts to repair the dural defect were needed, and no lumbar drains were used. No patients developed CSF otorrhea, rhinorrhea, or incisional leak postoperatively.

Conclusion Primary dural closure is possible in retrosigmoid approaches without the use of allo- or autografts and may prevent postoperative CSF leaks when combined with other posterior fossa closure techniques. Careful attention to the handling of the dural flap is necessary to achieve this.

Keywords

retrosigmoid craniotomy - retrosigmoid approach - primary dural closure - CSF leak

Note

No part of this paper has been published or previously presented.


 

  • References

  • 1 Hardy DG, Macfarlane R, Moffat DA. Wound closure after acoustic neuroma surgery. Br J Neurosurg 1993; 7 (02) 171-174
    CrossrefPubMedGoogle Scholar
  • 2 Brennan JW, Rowed DW, Nedzelski JM, Chen JM. Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach on incidence and response to treatment. J Neurosurg 2001; 94 (02) 217-223
    CrossrefPubMedGoogle Scholar
  • 3 Becker SS, Jackler RK, Pitts LH. Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches. Otol Neurotol 2003; 24 (01) 107-112
    CrossrefPubMedGoogle Scholar
  • 4 Ansari SF, Terry C, Cohen-Gadol AA. Surgery for vestibular schwannomas: a systematic review of complications by approach. Neurosurg Focus 2012; 33 (03) E14
    PubMedGoogle Scholar
  • 5 Baird CJ, Hdeib A, Suk I. , et al. Reduction of cerebrospinal fluid rhinorrhea after vestibular schwannoma surgery by reconstruction of the drilled porus acusticus with hydroxyapatite bone cement. J Neurosurg 2007; 107 (02) 347-351
    CrossrefPubMedGoogle Scholar
  • 6 Copeland WR, Mallory GW, Neff BA, Driscoll CL, Link MJ. Are there modifiable risk factors to prevent a cerebrospinal fluid leak following vestibular schwannoma surgery?. J Neurosurg 2015; 122 (02) 312-316
    CrossrefPubMedGoogle Scholar
  • 7 Fishman AJ, Marrinan MS, Golfinos JG, Cohen NL, Roland Jr JT. Prevention and management of cerebrospinal fluid leak following vestibular schwannoma surgery. Laryngoscope 2004; 114 (03) 501-505
    CrossrefPubMedGoogle Scholar
  • 8 Fishman AJ, Hoffman RA, Roland Jr JT, Lebowitz RA, Cohen NL. Cerebrospinal fluid drainage in the management of CSF leak following acoustic neuroma surgery. Laryngoscope 1996; 106 (08) 1002-1004
    CrossrefPubMedGoogle Scholar
  • 9 Cueva RA, Mastrodimos B. Approach design and closure techniques to minimize cerebrospinal fluid leak after cerebellopontine angle tumor surgery. Otol Neurotol 2005; 26 (06) 1176-1181
    CrossrefPubMedGoogle Scholar
  • 10 Ling PY, Mendelson ZS, Reddy RK, Jyung RW, Liu JK. Reconstruction after retrosigmoid approaches using autologous fat graft-assisted Medpor Titan cranioplasty: assessment of postoperative cerebrospinal fluid leaks and headaches in 60 cases. Acta Neurochir (Wien) 2014; 156 (10) 1879-1888
    CrossrefPubMedGoogle Scholar
  • 11 Selesnick SH, Liu JC, Jen A, Newman J. The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery. Otol Neurotol 2004; 25 (03) 387-393
    CrossrefPubMedGoogle Scholar
  • 12 Selesnick SH, Liu JC, Jen A, Carew JF. Management options for cerebrospinal fluid leak after vestibular schwannoma surgery and introduction of an innovative treatment. Otol Neurotol 2004; 25 (04) 580-586
    CrossrefPubMedGoogle Scholar
  • 13 Della Pepa GM, Montano N, Lucantoni C, Alexandre AM, Papacci F, Meglio M. Craniotomy repair with the retrosigmoid approach: the impact on quality of life of meticulous reconstruction of anatomical layers. Acta Neurochir (Wien) 2011; 153 (11) 2255-2258
    CrossrefPubMedGoogle Scholar
  • 14 Eseonu CI, Goodwin CR, Zhou X. , et al. Reduced CSF leak in complete calvarial reconstructions of microvascular decompression craniectomies using calcium phosphate cement. J Neurosurg 2015; 123 (06) 1476-1479
    CrossrefPubMedGoogle Scholar
  • 15 Gal TJ, Bartels LJ. Use of bone wax in the prevention of cerebrospinal fluid fistula in acoustic neuroma surgery. Laryngoscope 1999; 109 (01) 167-169
    CrossrefPubMedGoogle Scholar
  • 16 Yamakami I, Uchino Y, Kobayashi E, Yamaura A, Oka N. Removal of large acoustic neurinomas (vestibular schwannomas) by the retrosigmoid approach with no mortality and minimal morbidity. J Neurol Neurosurg Psychiatry 2004; 75 (03) 453-458
    CrossrefPubMedGoogle Scholar
  • 17 Grotenhuis JA. Costs of postoperative cerebrospinal fluid leakage: 1-year, retrospective analysis of 412 consecutive nontrauma cases. Surg Neurol 2005; 64 (06) 490-493 , discussion 493–494
    CrossrefPubMedGoogle Scholar
  • 18 Hendricks BL, Shikary TA, Zimmer LA. Causes for 30-day readmission following transsphenoidal surgery. Otolaryngol Head Neck Surg 2016; Feb; 154 (02) 359-365 . doi: 10.1177/0194599815617130
    CrossrefPubMedGoogle Scholar
  • 19 Wu H, Kalamarides M, Garem HE, Rey A, Sterkers O. Comparison of different wound closure techniques in translabyrinthine acoustic neuroma surgery. Skull Base Surg 1999; 9 (04) 239-242
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Leonetti J, Anderson D, Marzo S, Moynihan G. Cerebrospinal fluid fistula after transtemporal skull base surgery. Otolaryngol Head Neck Surg 2001; 124 (05) 511-514
    CrossrefPubMedGoogle Scholar
  • 21 Schiariti M, Acerbi F, Broggi M. , et al. Two alternative dural sealing techniques in posterior fossa surgery: (polylactide-co-glycolide) self-adhesive resorbable membrane versus polyethylene glycol hydrogel. Surg Neurol Int 2014; 5: 171
    CrossrefPubMedGoogle Scholar
  • 22 Abla AA, Link T, Fusco D, Wilson DA, Sonntag VK. Comparison of dural grafts in Chiari decompression surgery: review of the literature. J Craniovertebr Junction Spine 2010; 1 (01) 29-37
    CrossrefPubMedGoogle Scholar
  • 23 Bayazit YA, Celenk F, Duzlu M, Goksu N. Management of cerebrospinal fluid leak following retrosigmoid posterior cranial fossa surgery. ORL J Otorhinolaryngol Relat Spec 2009; 71 (06) 329-333
    CrossrefPubMedGoogle Scholar
  • 24 Nonaka Y, Fukushima T, Watanabe K. , et al. Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade. Neurosurgery 2013; 72 (2 Suppl Operative) ons103-ons115 , discussion ons115
    PubMedGoogle Scholar
  • 25 Quiñones-Hinojosa A, Schmidek HH. Schmidek & Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results. 6th ed. Philadelphia, PA: Elsevier/Saunders; 2012
    Google Scholar
  • 26 Megyesi JF, Ranger A, MacDonald W, Del Maestro RF. Suturing technique and the integrity of dural closures: an in vitro study. Neurosurgery 2004; 55 (04) 950-954 , discussion 954–955
    CrossrefPubMedGoogle Scholar
  • 27 An J, Liao H, Kucko NW. , et al. Long-term evaluation of the degradation behavior of three apatite-forming calcium phosphate cements. J Biomed Mater Res A 2016; 104 (05) 1072-1081
    CrossrefPubMedGoogle Scholar
  • 28 Macario A. What does one minute of operating room time cost?. J Clin Anesth 2010; 22 (04) 233-236
    CrossrefPubMedGoogle Scholar