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. 2018 Aug;79(4):330-334.
doi: 10.1055/s-0037-1607455. Epub 2017 Nov 10.

Primary Dural Closure for Retrosigmoid Approaches

Garrett T Venable  1 , Mallory L Roberts  1 , Ryan P Lee  1 , L Madison Michael 2nd  2   3
Affiliations

Primary Dural Closure for Retrosigmoid Approaches

Garrett T Venable et al. J Neurol Surg B Skull Base. 2018 Aug.

Abstract

Object Primary closure of posterior fossa dura can be challenging, and postoperative cerebrospinal fluid (CSF) leaks continue to represent a common complication of the retrosigmoid approach. We describe a simple technique to allow for primary closure of the dura following retrosigmoid approaches. The incidence of CSF leaks using this method is reported. Methods A retrospective chart review was conducted on all cases of retrosigmoid craniotomies performed by the senior surgeon from February 2009 to February 2015. The primary outcome was development of postoperative CSF leak or pseudomeningocele. Length of stay, lesion type, and other surgical complications were also reported. Results Eighty-six patients underwent a retrosigmoid craniotomy during the study period. The most common indications for retrosigmoid craniotomy were microvascular decompression (58%) and tumor resection (36%). No allo- or autografts to repair the dural defect were needed, and no lumbar drains were used. No patients developed CSF otorrhea, rhinorrhea, or incisional leak postoperatively. Conclusion Primary dural closure is possible in retrosigmoid approaches without the use of allo- or autografts and may prevent postoperative CSF leaks when combined with other posterior fossa closure techniques. Careful attention to the handling of the dural flap is necessary to achieve this.

Keywords: CSF leak; primary dural closure; retrosigmoid approach; retrosigmoid craniotomy.

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Conflict of interest statement

Conflict of Interest The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

Fig. 1
Fig. 1
Bony exposure of a typical microvascular decompression case. The distal transverse sinus and proximal sigmoid sinus are visualized.
Fig. 2
Fig. 2
The dura is initially incised along the inferior border of the transverse sinus. It is then carried inferiorly just posterior to the sigmoid sinus.
Fig. 3
Fig. 3
Stay sutures are placed along the venous sinus side of the dural opening.
Fig. 4
Fig. 4
The dural flap is left directly on the moist surface of the cerebellum and is covered by a moist cotton patty.
Fig. 5
Fig. 5
Primary closure of a microvascular decompression case is demonstrated here.
Fig. 6
Fig. 6
Reconstruction of the bony defect is performed using titanium mesh.
See this image and copyright information in PMC

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