Abstract
Introduction Tumors of the lateral skull base often require collaboration between neurosurgeons
and neurotologists for the surgical approach. The three main transosseous surgical
approaches are retrosigmoid (RS), translabyrinthine (TL), and middle fossa (MF). The
literature reflects a relative paucity regarding the various closure techniques for
these approaches and the postoperative complications. We have performed a systematic
review comparing closure techniques from each approach.
Methods A systematic review was performed using Ovid MEDLINE (1990–2016) on closure technique
and postoperative complications for patients undergoing lateral skull base surgery
via the TL, RS, or MF approach. Studies were included if they contained at least 10
patients, described their closure technique, and provided data on postoperative complications.
Results A total of 1,403 studies were reviewed. Of these, 53 studies met inclusion criteria
yielding a total of 10,466 subjects in this analysis. The average rate of cerebrospinal
fluid leak was 5.3% in the TL approach, 9% in the RS approach, and 6.2% in the MF
approach. There was no significant effect of various closure techniques on postoperative
wound complications in the MF approach. Multiple factors were identified which affected
postoperative wound complication in the RS and TL approaches.
Conclusion There are a plethora of closure techniques for lateral skull base surgery. Several
techniques were identified in this review that may affect the postoperative wound
complication rates in lateral skull base surgery.
Keywords
lateral skull base - retrosigmoid - translabyrinthine - middle fossa - postoperative
complications - systematic review - closure technique
