Prevention of cerebrospinal fluid leak after translabyrinthine resection of vestibular schwannoma

Abstract

Objective: Evaluate the rate of cerebrospinal fluid (CSF) leak after translabyrinthine craniotomy for the removal of vestibular schwannoma and describe details of closure technique.

Study design: Retrospective case review.

Setting: Tertiary referral center.

Patients: All individuals undergoing translabyrinthine craniotomy for removal of vestibular schwannoma from January 2000 to October 2008.

Intervention: Translabyrinthine craniotomy for removal of vestibular schwannoma with abdominal fat graft harvest and layered closure.

Main outcome measures: Presence of cerebrospinal fluid leak and need for additional surgeries or medical interventions.

Results: Sixty-one patients underwent translabyrinthine craniotomy for the removal of vestibular schwannoma during a 9-year period. None of the patients had a CSF leak in the immediate postoperative period or during the mean follow-up period of 31.3 months.

Conclusion: Successful wound closure and CSF leak prevention after translabyrinthine craniotomy for the removal of vestibular schwannomas do not require the creation of a facial recess, manipulation of the ossicles, direct Eustachian tube plugging, or the use of alloplastic space-occupying materials. The closure technique used in the current study has proven effective over time with no evidence of CSF leak among patients seen in follow-up.