Highlights
- •CSF leakage can occur after retrosigmoid transmeatal resection of acoustic neuroma.
- •We describe our technique of internal auditory canal closure using fat graft.
- •The technique, results, and complications are reported in 24 consecutive patients.
- •There were no instances of postoperative CSF leakage using this technique.
- •Fat grafts are viable options for repairing IAC defects to prevent CSF leakage.
Abstract
The retrosigmoid transmeatal approach remains an important strategy in the surgical
management of acoustic neuromas. Gross total resection of acoustic neuromas requires
removal of tumor within the cerebellopontine angle as well as tumor involving the
internal auditory canal (IAC). Drilling into the petrous bone of the IAC can expose
petrous air cells, which can potentially result in a fistulous tract to the nasopharynx
manifesting as cerebrospinal fluid (CSF) rhinorrhea. We describe our method of IAC
closure using autologous fat graft and assessed the rates of postoperative CSF leakage.
We performed a retrospective study of 24 consecutive patients who underwent retrosigmoid
transmeatal resection of acoustic neuroma who underwent our method of fat graft-assisted
IAC closure. We assessed rates of postoperative CSF leak (incisional leak, rhinorrhea,
or otorrhea), pseudomeningocele formation, and occurrence of meningitis. Twenty-four
patients (10 males, 14 females) with a mean age of 47 years (range 18–84) underwent fat graft-assisted IAC closure. No lumbar drains were
used postoperatively. There were no instances of postoperative CSF leak (incisional
leak, rhinorrhea, or otorrhea), pseudomeningocele formation, or occurrence of meningitis.
There were no graft site complications. Our results demonstrate that autologous fat
grafts provide a safe and effective method of IAC defect closure to prevent postoperative
CSF leakage after acoustic tumor removal via a retrosigmoid transmeatal approach.
The surgical technique and operative nuances are described.
Keywords
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References
- Impact of video-endoscopy on the results of retrosigmoid-transmeatal microsurgery of vestibular schwannoma: prospective study.Eur Arch Otorhinolaryngol. 2013; 270: 1277-1284
- Petrous bone pneumatization is a risk factor for cerebrospinal fluid fistula following vestibular schwannoma surgery.Neurosurgery. 2010; 67: 509-515
- Endoscopically assisted prevention of cerebrospinal fluid leak in suboccipital acoustic neuroma surgery.Am J Otol. 1997; 18: 381-385
- Current surgical results of retrosigmoid approach in extralarge vestibular schwannomas.Surg Neurol. 2000; 53 ([discussion 377–8]): 370-377
- Posterior internal auditory canal closure following the retrosigmoid approach to the cerebellopontine angle.Am J Otol. 1993; 14: 31-33
- Cerebrospinal fluid leak after microsurgical surgery in vestibular schwannomas via retrosigmoidal craniotomy.Neurol Res. 2011; 33: 947-952
- Acoustic neuroma surgery as an interdisciplinary approach: a neurosurgical series of 508 patients.J Neurol Neurosurg Psychiatry. 2000; 69: 161-166
- Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches.Otol Neurotol. 2003; 24: 107-112
- Reduction of cerebrospinal fluid rhinorrhea after vestibular schwannoma surgery by reconstruction of the drilled porus acusticus with hydroxyapatite bone cement.J Neurosurg. 2007; 107: 347-351
- Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach on incidence and response to treatment.J Neurosurg. 2001; 94: 217-223
- Cerebrospinal fluid leak after retrosigmoid excision of vestibular schwannomas.Otol Neurotol. 2008; 29: 384-386
- Prevention and management of cerebrospinal fluid leak following vestibular schwannoma surgery.Laryngoscope. 2004; 114: 501-505
- Surgical treatment of large vestibular schwannomas (stages III and IV).Eur Ann Otorhinolaryngol Head Neck Dis. 2010; 127: 63-69
- Reconstruction of cranial base defects using the Medpor Titan implant: cranioplasty applications in acoustic neuroma surgery.Laryngoscope. 2013; 123: 1361-1368
- Reconstruction after retrosigmoid approaches using autologous fat graft-assisted Medpor Titan cranioplasty: assessment of postoperative cerebrospinal fluid leaks and headaches in 60 cases.Acta Neurochirurgica (Wien). 2014; 156: 1879-1988
- Retrosigmoid approach to cerebellopontine angle tumor resection: surgical modifications.Laryngoscope. 2012; 122: 2519-2523
- Cerebrospinal fluid leaks following spinal or posterior fossa surgery: use of fat grafts for prevention and repair.Neurosurg Focus. 2000; 9: e4
- Revascularization determines volume retention and gene expression by fat grafts in mice.Exp Biol Med (Maywood, NJ). 2005; 230: 742-748
- Use of bone wax in the prevention of cerebrospinal fluid fistula in acoustic neuroma surgery.Laryngoscope. 1999; 109: 167-169
Article info
Publication history
Published online: September 18, 2015
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© 2015 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
