Primary Dural Closure for Retrosigmoid Approaches
Open Access
- 10 November 2017
- journal article
- research article
- Published by Georg Thieme Verlag KG in Journal of Neurological Surgery Part B: Skull Base
- Vol. 79 (04), 330-334
- https://doi.org/10.1055/s-0037-1607455
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. No part of this paper has been published or previously presented.Keywords
This publication has 27 references indexed in Scilit:
- Surgery for vestibular schwannomas: a systematic review of complications by approachNeurosurgical Focus, 2012
- Craniotomy repair with the retrosigmoid approach: the impact on quality of life of meticulous reconstruction of anatomical layersActa Neurochirurgica, 2011
- Comparison of dural grafts in Chiari decompression surgery: Review of the literatureJournal of Craniovertebral Junction & Spine, 2010
- Management of Cerebrospinal Fluid Leak following Retrosigmoid Posterior Cranial Fossa SurgeryORL, 2009
- Reduction of cerebrospinal fluid rhinorrhea after vestibular schwannoma surgery by reconstruction of the drilled porus acusticus with hydroxyapatite bone cementJournal of Neurosurgery, 2007
- Costs of postoperative cerebrospinal fluid leakage: 1-year, retrospective analysis of 412 consecutive nontrauma casesSurgical Neurology, 2005
- Prevention and Management of Cerebrospinal Fluid Leak Following Vestibular Schwannoma SurgeryThe Laryngoscope, 2004
- Removal of large acoustic neurinomas (vestibular schwannomas) by the retrosigmoid approach with no mortality and minimal morbidityJournal of Neurology, Neurosurgery & Psychiatry, 2004
- Cerebrospinal Fluid Drainage in the Management of CSF Leak Following Acoustic Neuroma SurgeryThe Laryngoscope, 1996
- Wound closure after acoustic neuroma surgeryBritish Journal of Neurosurgery, 1993