Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa

Cooper, Matthew; Ward, Bryan K.; Sharon, Jeffrey D.; Francis, Howard W.

doi:10.1016/j.wjorl.2021.01.003

Cited by 5 publications

(21 citation statements)

References 12 publications

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“…Thirteen studies 15,20,21,28,[31][32][33][35][36][37][38][39]43 performed fat packing in isolation with no reported adjuncts. Some institutions [40][41][42] attempted to mitigate This article is protected by copyright. All rights reserved.…”

Section: Dural Phasementioning

confidence: 99%

“…Several studies reported an onlay technique to seal the dura, employing autologous grafts, xenografts and synthetic dural substitutes. 17,21,22,25,42,[47][48][49][50] Autologous onlays consisted of fascia grafts, harvested either from the abdomen or thigh. 17,22,25,42,48,51 Variations in the autologous onlay technique centred around the size of the graft used, ranging from slightly larger than the dural defect to a 'peri cranial graft basket' 47 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…17,21,22,25,42,[47][48][49][50] Autologous onlays consisted of fascia grafts, harvested either from the abdomen or thigh. 17,22,25,42,48,51 Variations in the autologous onlay technique centred around the size of the graft used, ranging from slightly larger than the dural defect to a 'peri cranial graft basket' 47 . Advantages of autologous grafts include their cost profile, universal availability, and high compatibility with the local tissue environment, while drawbacks include donor site-related complications and increased operative times.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Air Cellsmentioning

confidence: 99%

“…While HAC is more costly compared to bone wax, its liquid consistency enables an effective seal of air cells without a surgeon manually pressing wax into the air cell spaces. 22,24,30,42 . Overall, no study compared air cell treatment materials and techniques were frequently combined on an ad hoc basis.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

See 4 more Smart Citations

Skull Base Repair following Resection of Vestibular Schwannoma: A Systematic Review (Part 2: The Translabyrinthine Approach)

Starup-Hansen,

Williams,

Valetopoulou

et al. 2023

J Neurol Surg B Skull Base

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Objectives: Despite advances in skull base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a relatively common complication after translabyrinthine (TL) vestibular schwannoma (VS) surgery. We conducted a systematic review to synthesise the repair techniques and materials used in TL VS surgery to prevent CSF leaks. Design: A systematic review of studies published since 2000 reporting techniques to prevent CSF leaks during adult TL VS surgery was conducted. A narrative synthesis of primary repair protocols was produced, and a taxonomy was established. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were extracted. Results: All 43 studies were case series, and 39 were retrospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A taxonomy was produced, classifying repairs into seven distinct stages, including approaches to the dura, middle ear cleft, air cells, TL bony defect, extra-cranial soft tissue, post-operative dressings and CSF diversion. The median post-operative incidence of CSF leaks was 6% (IQR 0-10%). Conclusions: This systematic review reveals substantial inter-institutional heterogeneity in intraoperative strategies to prevent CSF leaks following TL VS surgery. However, comparing these techniques is challenging due to the multiple predictive factors for CSF leaks and their inconsistent reporting. We propose a taxonomy of seven stages to classify operative techniques and materials aimed at preventing CSF leaks. We recommend that future evaluations should adopt a prospective approach encompassing data collection strategies that consider all operative stages described by our taxonomy.

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