Prevention and Management of Cerebrospinal Fluid Leak Following Vestibular Schwannoma Surgery

Fishman, Andrew J.; Marrinan, Michelle Siegel; Golfinos, John G.; Cohen, Noel L.; Roland, J. Thomas

doi:10.1097/00005537-200403000-00022

Cited by 120 publications

(120 citation statements)

References 5 publications

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“…The advent of the translabyrinthine approach has improved the management of VS [7] , despite the fact that some postoperative complications remain considerable. This is the case of cerebrospinal fluid (CSF) leaks [8][9][10] , the second most common complication of VS resection [10,11] . Although its incidence is negligible in some studies, it can reach as much as 20% in others, and even more so when considering only large tumors [7,8,12] .…”

Section: Introductionmentioning

confidence: 99%

“…Although its incidence is negligible in some studies, it can reach as much as 20% in others, and even more so when considering only large tumors [7,8,12] . CSF leaks results from a communication way that takes place between the subarachnoid space, the mastoid air cells, the middle ear, the petrous apex air cells, and finally either the Eustachian tube (ET), the surgical incision, or a tear in the tympanic membrane [7][8][9][10][12][13][14][15][16][17] . Consequently, the complication can respectively manifest as a rhinoliquorrhea, a wound discharge or an otorrhea [8,18] .…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, the complication can respectively manifest as a rhinoliquorrhea, a wound discharge or an otorrhea [8,18] . CSF leak is critical, as it prolongs the duration of the hospitalization and increases the risk of meningitis up to 19% [7,10,12,15,19] . Once objectified by the clinician, it can often be managed conservatively (bed rest, head elevation, pressure dressings) [7,8,10,12,20] but may also require invasive procedures (lumbar drain, surgical intervention) [21] .…”

Section: Introductionmentioning

confidence: 99%

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Eustachian Tube Obliteration and its Effect on Rhinoliquorrhea in Translabyrinthine Vestibular Schwannoma Excision

Moderie

Maniakas²,

Moumdjian³

et al. 2017

Int Adv Otol

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OBJECTIVE:Rhinoliquorrhea is defined as a cerebrospinal fluid leakage from the nose. Our objective in this study is to determine the reduction of rhinoliquorrhea rates by Eustachian tube (ET) obliteration in the context of a translabyrinthine approach performed following vestibular schwannoma (VS) excision. MATERIALS and METHODS:This is a prospective study achieved in a tertiary-care center where the chart review revealed 94 VS operated by the translabyrinthine approach between 2009 and 2015. There were 40 males and 54 females aged from 28-76 years. The only exclusion criterion was a previous history of cranial surgery. ET obliteration was systematically executed when the petrous apex pneumatization level was at least 2 of 4. Our main outcome measure was the development of rhinoliquorrhea. RESULTS:Eighty-eight patients underwent ET obliteration and were followed for an average of 2.6±1.2 years. Rhinoliquorrhea was reported in 1.14% of the patients having had an ET obliteration. When compared to our previous sample of patients operated with a translabyrinthine approach, it represents a reduction of 84%. CONCLUSION:Obliteration of the ET is a fast and simple procedure that reduces the rate of rhinoliquorrhea. We therefore recommend its use, specifically in cases of petrous apex pneumatization levels 2-4.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Eustachian Tube Obliteration and its Effect on Rhinoliquorrhea in Translabyrinthine Vestibular Schwannoma Excision

Moderie

Maniakas²,

Moumdjian³

et al. 2017

Int Adv Otol

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“…5,27,30 Postoperative CSF leak rates for all acoustic neuroma surgery have been reported to range between 0% and 30% in the literature, but the mean leak rate remains approximately 10%. 1,[8][9][10]15,17,26,27 The postoperative CSF leak rates after translabyrinthine removal of acoustic neuromas range from 0% to 13% as reported in the most recent literature. 3,6,7,11,18,19,29 Reconstruction of presigmoid dural defects after resection of acoustic neuromas via the translabyrinthine approach is paramount to prevent postoperative CSF leakage.…”

mentioning

confidence: 99%

“…10,31 In this technique, the fat graft is in direct contact with the facial nerve, brainstem, and cerebellum. When the fat is overpacked and under pressure, symptomatic compression of the brainstem, cerebellum, and facial nerve can occur.…”

mentioning

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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Retrosigmoid approach to cerebellopontine angle tumor resection: Surgical modifications

et al. 2012

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Prevention and Management of Cerebrospinal Fluid Leak Following Vestibular Schwannoma Surgery

Cited by 120 publications

References 5 publications

Eustachian Tube Obliteration and its Effect on Rhinoliquorrhea in Translabyrinthine Vestibular Schwannoma Excision

Eustachian Tube Obliteration and its Effect on Rhinoliquorrhea in Translabyrinthine Vestibular Schwannoma Excision

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

Retrosigmoid approach to cerebellopontine angle tumor resection: Surgical modifications

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