Preoperative risk assessment for predicting the opening of mastoid air cells in lateral suboccipital craniotomy for microvascular decompression

Utilization of three-dimensional fusion images with high-resolution computed tomography angiography for preoperative evaluation of microvascular decompression: patient series

“… 11 , 12 , 14 Furthermore, although plain CT is widely utilized as a preoperative imaging modality for MVD to obtain anatomical information about the mastoid air cells, CTA can also provide essential information on the transverse sinus and sigmoid sinus location, which is important for lateral suboccipital craniotomy. 15 , 16 …”

“…11,12,14 Furthermore, although plain CT is widely utilized as a preoperative imaging modality for MVD to obtain anatomical information about the mastoid air cells, CTA can also provide essential information on the transverse sinus and sigmoid sinus location, which is important for lateral suboccipital craniotomy. 15,16 Our study highlighted the importance of obtaining detailed preoperative anatomical information to improve surgical safety and outcomes, particularly because smaller arterial branches may compress nerves in addition to the main trunk artery. Our reasoning for recommending high-resolution CTA, despite its requirement for contrast and radiation exposure, is based on its ability to offer detailed preoperative identification of compressing vessels and their peripheral locations.…”

Risk Factors for Central Nervous System Infections After Craniotomy

“…Cerebrospinal fluid rhinorrhea and cerebrospinal fluid otorrhea are usually caused by the opening of the paranasal sinuses and mastoid air cells during the craniotomy, which is not tightly sealed with bone wax, and the dura meter is not tightly sutured when the skull is closed. 27 , 29 , 32 At this time, cerebrospinal fluid can flow out through the paranasal sinuses and mastoid air cells, resulting in cerebrospinal fluid rhinorrhea and otorrhea. Then, the channels between the intracranial and extracranial regions are formed, and pathogenic bacteria may enter the brain, causing infection of the CNS ( Figures 2 and 3 ).…”

“…As a foreign body, it should be noted that artificial dura mater may aggravate the intracranial infection in open traumatic brain injury. 32 For the parts where the tissue is loose and can quickly form subcutaneous effusion, a local compression bandage should be placed after the surgery to prevent the occurrence of subcutaneous effusion. These measures will reduce the incidence of intracranial infection after craniotomy.…”

“…To prevent cerebrospinal fluid rhinorrhea and otorrhea after surgery, the barrier among the cranial cavity, the paranasal sinuses, and the mastoid air cells should be repaired before the skull is closed. 32 Once cerebrospinal fluid rhinorrhea and otorrhea occur, the nostril and ear canal should not be blocked. The cerebrospinal fluid should be thoroughly drained to promote the early closure of the external channel and cranial cavity.…”