Petrous Bone Pneumatization Is a Risk Factor for Cerebrospinal Fluid Fistula Following Vestibular Schwannoma Surgery

Stieglitz, Lennart; Giordano, Mario; Gerganov, Venelin; Raabe, Andreas; Samii, Amir; Samii, M.; Lüdemann, Wolf

doi:10.1227/neu.0b013e3181f88884

Cited by 29 publications

(32 citation statements)

References 21 publications

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“…These air cells are of major concern in vestibular schwannoma surgery as they are known as the origin of CSF fistulae. [31] Apical cells are anatomically located anterior-medial to the internal auditory canal (IAC) and posterior medial to the carotid canal, again consistently present in group 3. These cells significantly contributed to the total volume of the temporal bone in the present study.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Classification and volumetric analysis of temporal bone pneumatization using cone beam computed tomography

Fellows

Hand

Tadinada

et al. 2014

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

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Section: Discussionmentioning

confidence: 99%

“…The pneumatized petrous apex is frequently responsible for CSF leakage after skull base surgery. Stieglitz et al showed that a 10% increase in petrous bone pneumatization increased the risk of CSF fistulae by 26% [31].…”

Section: Discussionmentioning

confidence: 99%

Classification and volumetric analysis of temporal bone pneumatization using cone beam computed tomography

Fellows

Hand

Tadinada

et al. 2014

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

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“…However, postoperative CSF leak has been the most frequent serious complication in VS surgery. [45][46][47][48][49][50][51][52][53] Many reports have discussed different factors leading to postoperative CSF leaks. Pirouzmand et al 54 and Yasargil 53 suggested that hydrocephalus was the main cause of CSF leaks.…”

Section: Nonneurological Complications Csf Leakmentioning

confidence: 99%

Contemporary Surgical Management of Vestibular Schwannomas

Nonaka

Fukushima

Watanabe

et al. 2013

Operative Neurosurgery

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“…48,50,57 We believe that obliteration of the opened air cells with bone wax is the most important step in avoiding CSF leak after TLAN. 26,53 Most surgeons use a dry sheet of Gelfoam to cover the dura before cement application as it facilitates graft adjustment without manipulation near the dura mater. We have used a layer of DuraGen with dural sealant before layering the temporalis fascia to ensure watertight closure.…”

Section: Discussionmentioning

confidence: 99%

Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh–hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma

Manjila¹,

Weidenbecher

Semaan

et al. 2013

JNS

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PostoPerative CSF leak after translabyrinthine surgery for removal of an acoustic neuroma (TLAN) is recognized as an infrequent complication, despite the best prophylactic techniques currently available. [29][30][31][32][33]36,40,44 To prevent postoperative CSF leaks after TLAN, several surgical methods have been tried, using different autografts and allografts, alone or in combinations, with varying success rates. 6,8,10,11,13,[22][23][24]27,28,42,46 These range from calvarial bone autografts, bone cements, metals, and resins to resorbable bone plates. 5,6,51 Calvarial grafts can be time consuming and less malleaPrevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh-hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma Object. Several prophylactic surgical methods have been tried to prevent CSF leakage after translabyrinthine resection of acoustic neuroma (TLAN). The authors report an improvised technique for multilayer watertight closure using titanium mesh-hydroxyapatite cement (HAC) cranioplasty in addition to dural substitute and abdominal fat graft after TLAN.Methods. The study was limited to 42 patients who underwent TLAN at University Hospitals Case Medical Center using this new technique from 2006 to 2012. Systematic closure of the surgical wound in layers using temporalis fascia, dural substitute, dural sealant, adipose graft, titanium mesh, and then HAC was performed in each case. Temporalis muscle and eustachian tube obliteration were not used. The main variables studied were patient age, tumor size, tumor location, cosmetic outcome, length of hospitalization, and the incidence of CSF leak, pseudomeningocele, and infection.Results. Excellent cosmetic outcome was achieved in all patients. There were no cases of postoperative CSF rhinorrhea, incisional CSF leak, or meningitis. Cosmetic results were comparable to those achieved using HAC alone. This cost-effective technique used only a third of the HAC required for traditional closure in which the entire mastoid defect is filled with cement, predisposing to infection. Postoperative CT and MRI showed excellent bony contouring and dural reconstitution, respectively.Conclusions. The authors report on successful use of titanium mesh-HAC cranioplasty in preventing postoperative CSF leak after TLAN in all cases in their series. The titanium mesh provides a well-defined anatomical dissection plane that would make reoperation easier than working through scarred soft tissue. The mesh bolsters the fat graft and keeps HAC out of direct contact with mastoid air cells, thereby reducing the risk of infection. The cement cranioplasty does not preclude subsequent implantation of a bone-anchored hearing aid.

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Petrous Bone Pneumatization Is a Risk Factor for Cerebrospinal Fluid Fistula Following Vestibular Schwannoma Surgery

Cited by 29 publications

References 21 publications

Classification and volumetric analysis of temporal bone pneumatization using cone beam computed tomography

Classification and volumetric analysis of temporal bone pneumatization using cone beam computed tomography

Contemporary Surgical Management of Vestibular Schwannomas

Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh–hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma

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