Cerebrospinal fluid leak following acoustic neuroma removal

Hoffman, Ronald A.

doi:10.1288/00005537-199401000-00009

Cited by 126 publications

(109 citation statements)

References 84 publications

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“…CSF leakage occurs in 10% of cases after suboccipital transmeatal removal of vestibular schwannoma. 9) There are two potential routes for CSF leakage, the mastoid air cells exposed by the suboccipital craniotomy and the surrounding air cells exposed by IAM opening. 7,13,19,22) CSF leakage through the air cells around the IAM occurs less frequently, but is less likely to be cured by lumbar CSF drainage and may need surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Changes in the Internal Acoustic Meatus Caused by Vestibular Schwannoma.

Yamakami

Uchino

Kobayashi

et al. 2002

Neurol. Med. Chir.(Tokyo)

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The prognostic significance of the variety of changes in the internal auditory meatus (IAM) caused by vestibular schwannoma was retrospectively analyzed in 69 consecutive patients with vestibular schwannoma. Preoperative bone-window computed tomography was used to classify IAM changes into extensive destruction (17%), widening (46%), and normal IAM (36%). Extensive destruction (47 ± 19 years) and widening (48 ± 13) occurred in significantly younger patients than normal IAM (59 ± 9). Preoperative hearing was significantly more severely disturbed in patients with extensive destruction than in those with widening or normal IAM. IAM change was significantly related to the tumor consistency, as normal IAM was more common in patients with cystic tumor than in those with solid tumor. Postoperative hearing and facial function were worse in patients with severe IAM change, although the relationship between the IAM change and the surgical result was not significant. One patient with extensive destruction developed postoperative cerebrospinal fluid (CSF) leakage through the air cells around the IAM, and needed surgical repair. Severe IAM change occurs with solid tumor and causes severely disturbed preoperative hearing in younger patients, which reflects the tumor aggressiveness. Severe IAM change increases the technical difficulty of tumor removal and the risk of postoperative CSF leakage, and is associated with a poorer prognosis for patients with vestibular schwannoma.

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Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Changes in the Internal Acoustic Meatus Caused by Vestibular Schwannoma.

Yamakami

Uchino

Kobayashi

et al. 2002

Neurol. Med. Chir.(Tokyo)

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“…The presentation of CSF leaks may range from incisional, otorrhea (CSF leakage through the tympanic membrane), and rhinorrhea (CSF leakage through the eustachian tube and nasopharynx). 12,30 Following the transmastoid transtemporal petrosectomy required for the translabyrinthine approach, the mastoid antrum and mastoid air cells become exposed, enabling CSF to leak through if the air cells are not properly sealed. 30 Dural opening into the posterior cranial fossa provides direct communication between the subarachnoid space and the mastoid cells.…”

Section: Discussionmentioning

confidence: 99%

“…The CSF can then enter the middle ear via the aditus ad antrum, sinus tympani cells, facial recess cells, or retrofacial air cells. 12 Cerebrospinal fluid can also reach the temporal bone through apical air cells, which are located above and below the IAC. Therefore, it is critical to obliterate the mastoid antrum and remaining mastoid air cells, in addition to achieving a watertight dural closure to prevent fistulous pathways for CSF leakage.…”

Section: Discussionmentioning

confidence: 99%

Fascial sling technique for dural reconstruction after translabyrinthine resection of acoustic neuroma: technical note

Liu¹,

Patel

Podolski

et al. 2012

FOC

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Reconstruction of presigmoid dural defects after resection of acoustic neuromas via the translabyrinthine approach is paramount to prevent postoperative CSF leakage. However, primary dural reapproximation and achieving a watertight closure of the dural defect in this anatomical region are quite difficult. Standard closure techniques after the translabyrinthine approach often involve packing an abdominal fat graft that plugs the dural defect and mastoidectomy cavity. This technique, however, may pose the risk of direct compression of the fat graft on the facial nerve and brainstem. Nonetheless, even with the evolution in dural repair techniques, postoperative CSF leaks can still occur and provide a route for infection and meningitis. In this report, the authors describe a novel dural “sling” reconstruction technique using autologous fascia lata to repair presigmoid dural defects created after translabyrinthine resection of acoustic neuromas. The fascia lata is sewn to the edges of the presigmoid dural defect to create a sling to suspend the fat graft within the mastoidectomy defect. A titanium mesh plate embedded in porous polyethylene is secured over the mastoidectomy defect to apply pressure to the fat graft. In the authors' experience, this has been a successful technique for dural reconstruction after translabyrinthine removal of acoustic neuromas to prevent postoperative CSF leakage. There were no cases of CSF leakage in the first 8 patients treated using this technique. The operative details and preliminary results of this technique are presented.

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“…Hoffman 16 compared the surgical approach used in CPA tumor removals and found there was no significant difference in the rate of CSF leakage when comparing the translabyrinthine and retrosigmoid approaches (21% versus 16%, respectively). Becker and associates 4 reported that neither the tumor size nor the surgical approach had an effect on the rate of CSF leaks.…”

Section: Datamentioning

confidence: 99%

Utilization of Preoperative Cerebrospinal Fluid Drain in Skull Base Surgery

Bien¹,

Bowdino²,

Moore

et al. 2007

Skull Base

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Objective: Retrospectively assess the efficacy of lumbar cerebrospinal fluid (CSF) drainage placed preoperatively in skull base operations in decreasing the incidence of postoperative CSF fistula. Methods: A retrospective review of 150 patients undergoing a posterior fossa craniotomy from 1989 to 2000 was conducted. Patients were divided into those receiving preoperative lumbar drains and those that did not. The rates of postoperative CSF leakage were compared between the two groups. Patient data were analyzed to determine if there were other comorbidities affecting the postoperative incidence of CSF leakage such as smoking, diabetes, or hypertension. Results: Between 1989 and 1994, 25/72 (35%) patients with no preoperative lumbar drain had a postoperative CSF leak. From 1995 to 2000, 9/78 (12%) patients with a preoperative lumbar drain had a CSF leak. This was a 23% decreased incidence of postoperative CSF leakage and a significant decrease in the probability (p < 0.001) of CSF leakage in patients treated with a preoperative lumbar drain. The comorbidities of diabetes, smoking, or hypertension did not increase the probability of a CSF leak (p ¼ 0.43). Conclusions: A preoperatively placed lumbar drain can significantly lower the rate of postoperative CSF leakage after skull base surgery. The drain is a welltolerated adjunct to dural closure and helps increase surgical exposure of the posterior fossa. The comorbidities of diabetes, smoking, or hypertension do not contribute to an increased rate of CSF leakage.

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Cerebrospinal fluid leak following acoustic neuroma removal

Cited by 126 publications

References 84 publications

Prognostic Significance of Changes in the Internal Acoustic Meatus Caused by Vestibular Schwannoma.

Prognostic Significance of Changes in the Internal Acoustic Meatus Caused by Vestibular Schwannoma.

Fascial sling technique for dural reconstruction after translabyrinthine resection of acoustic neuroma: technical note

Utilization of Preoperative Cerebrospinal Fluid Drain in Skull Base Surgery

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