Sandwich Wound Closure Reduces the Risk of Cerebrospinal Fluid Leaks in Posterior Fossa Surgery

Abstract

Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.

Multi-Layer Onlay Graft Using Hydroxyapatite Cement Placement without Cerebrospinal Fluid Diversion for Endoscopic Skull Base Reconstruction

“…In addition, this concept is the same as that in the layer-by layer reconstruction method of duro-cranioplasty with a rotating scalp flap in transcranial approaches. FSP has been commonly used as a substitute in duroplasty for the prevention of CSF leakage in the transcranial approach and TSA, as it has a reliable repair rate and is safe [ 11 , 26 , 28 , 31 , 57 , 60 ]. However, it did not provide complete repair of the high-flow CSF leakage.…”

Assessment of the performance of Lyoplant® Onlay for duraplasty. An observational, multi-center Post Market Clinical Follow-up study

“…In two cases Lyoplant ® Onlay was used in a "sandwich-technique": one patch onlay and one as underlay (one posterior fossa and one spinal). In a clinical study this technique with a combination of autologous dura, dural substitute, and fibrin glue correlated with a significant reduction of CSF leaks in posterior fossa surgery 25 . Using bovine pericardium, it was also shown as beneficial in terms of blood loss and surgical time during subsequent cranioplasty 26 .…”

Liquorrhea after removal of fourth ventricle tumors in children. Retrospective analysis of a series of 211 primary surgeries

“…В детской нейрохирургической практике к пациентам с повышенным риском послеоперационной ликвореи традиционно относят все операции на ЗЧЯ [4,11,12]. Среди методов, снижающих риск ликвореи, в литературе рассматриваются различные модификации хирургической техники и добавление к шву ТМО герметизирующих препаратов и материалов [5,6,11,13,14].…”