Reduction of cerebrospinal fluid rhinorrhea after vestibular schwannoma surgery by reconstruction of the drilled porus acusticus with hydroxyapatite bone cement

Baird, Clinton J.; Hdeib, Alia; Suk, Ian; Francis, Howard W.; Holliday, Michael J.; Tamargo, Rafael J.; Brem, Henry; Long, Donlin M.

doi:10.3171/jns-07/08/0347

Cited by 32 publications

(31 citation statements)

References 19 publications

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“…Perimeatal cells may communicate with air cell tracts in the petrous apex, peritubal region, perilabyrinthine region, or retrofacial region. A CSF leak rate of 6.6% was identified in this current series, which was comparable to published rates with the standard retrosigmoid approach of 6% to 18.7% 8–12. Careful obliteration of air cells in the region of the IAC drill‐out is essential to eliminate potential routes for postoperative CSF leak.…”

Section: Discussionsupporting

confidence: 74%

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Retrosigmoid approach to cerebellopontine angle tumor resection: Surgical modifications

et al. 2012

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Section: Discussionsupporting

confidence: 74%

“…Additionally, within this series no patients experienced meningitis following the modified retrosigmoid approach. This is lower than previous reports in the literature of 1.5% to 3.7% for all approaches and approximately 3.8% to 7.3% for the retrosigmoid approach specifically 12, 14, 16…”

Section: Discussioncontrasting

confidence: 73%

Retrosigmoid approach to cerebellopontine angle tumor resection: Surgical modifications

et al. 2012

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“…Baird and colleagues have described a limited method of HAC use wherein cement is placed only around the drilled posterior wall of the porus acusticus, creating a significant reduction of their CSF leak rate from 12 to 2.3%. 20 We propose that the addition of titanium mesh to the closure limits the amount of HAC that must be used in replacing the bony defect caused by the mastoidectomy. In addition, we have found that the introduction of medial bowing to the mesh once it is secured to the cortex provides uniform and permanent pressure to the fat graft, allowing for a more effective seal of air-cell tracts than standard fat application techniques and potentially contributing to the lack of not only CSF leakage but also the incidence of subgaleal CSF effusions.…”

Section: Discussionmentioning

confidence: 99%

A Novel Method of Translabyrinthine Cranioplasty Using Hydroxyapatite Cement and Titanium Mesh: A Technical Report

Bambakidis

Munyon

et al. 2010

Skull Base

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We report a novel technique for closure using titanium mesh cranioplasty in addition to hydroxyapatite cement and abdominal fat graft for acoustic neuroma. We reviewed 15 patients who underwent translabyrinthine craniectomy for resection of acoustic neuroma. Hearing loss was documented prior to surgical procedure. Over 2 years, patients underwent titanium mesh and hydroxyapatite cranioplasty with abdominal fat graft. Participants included seven men and eight women, age range 38 to 65. Main outcome measures included cosmetic outcome and incidence of cerebrospinal fluid (CSF) leak. The lesion was right-sided in seven patients and left-sided in eight. Cosmetic outcome was excellent in all. There were no cases of CSF leak. Closure used one-third the hydroxyapatite required for traditional closure. Our technique yields cosmetic results equivalent to hydroxyapatite cement alone and a comparable incidence of CSF leakage without leaving a drain in place postoperatively. The technique is easy to adopt, is more cost-effective than hydroxyapatite cement cranioplasty alone, offers greater ease of access for reoperation, and does not preclude later implantation of bone-anchored hearing aid.

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“…[1910111726] While some authors have demonstrated HBC as an acceptable method of preventing CSF leaks in craniotomies of the skull base,[171112] others have used the cement as an adjunct to titanium mesh, plates, fat grafts, and/or dural substitutes. [218]…”

Section: Introductionmentioning

confidence: 99%

Hydroxyapatite bone cement application for the reconstruction of retrosigmoid craniectomy in the treatment of cranial nerves disorders

Aldahak¹,

Dupré²,

Ragaee³

et al. 2017

Surg Neurol Int

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Background:Retromastoid craniectomy (RSC) is a cardinal surgical approach used to access the posterior fossa. Hydroxyapetite bone cement (HBC) is frequently employed for cranioplasty in efforts to prevent cerebrospinal fluid (CSF) leak, whilst maintaining low complication rates and good cosmetic satisfaction. The authors aim to determine the safety and effectiveness of HBC for reconstruction RSC used for treatment of various cranial nerves disorders.Methods:The authors conducted a retrospective one-center two surgeons review of 113 patients who underwent RSC filled with HBC for the treatment of cranial nerve disorders. The study period extended from January 2011 through April 2016. Charts were reviewed for documentation of descriptors pertinent to the endpoints described above. Revisions and reoperations were excluded from analysis.Results:Ninety-three patients met the inclusion criteria; there was one case of postoperative pseudomeningocele, which was considered as CSF leak (1%), 3 (3,2%) superficial infections, and no deep infections. Cosmetic satisfaction was obtained in all but one case (98.9% satisfaction) and long-term incisional pain was problematic in 1 (1.1%) patient. Other complications (serous drainage, headache, ear pain) accounted for three cases (3.2%).Conclusions:The application of HBC in the reconstruction of RSC for the treatment of cranial nerves disorders is an effective method, yielding good cosmetic results whilst eliminating CSF leak. Additionally, it is safe due to the lack of deep-seated wound infections with low incidence of chronic incisional pain.

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Reduction of cerebrospinal fluid rhinorrhea after vestibular schwannoma surgery by reconstruction of the drilled porus acusticus with hydroxyapatite bone cement

Abstract: The use of HAC in the reconstruction of the drilled posterior wall of the porus acusticus, occluding exposed air cells, greatly reduces the risk of CSF rhinorrhea.

Cited by 32 publications

References 19 publications

Retrosigmoid approach to cerebellopontine angle tumor resection: Surgical modifications

Retrosigmoid approach to cerebellopontine angle tumor resection: Surgical modifications

A Novel Method of Translabyrinthine Cranioplasty Using Hydroxyapatite Cement and Titanium Mesh: A Technical Report

Hydroxyapatite bone cement application for the reconstruction of retrosigmoid craniectomy in the treatment of cranial nerves disorders

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