Article
Underlay hourglass-shaped autologous pericranium duraplasty in retrosigmoid approach surgeries – technical report
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Authors
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Luciano Mastronardi
- San Filippo Neri Hospital, Department of Neurosurgery, Roma, Italy
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Guglielmo Cacciotti
- San Filippo Neri Hospital, Department of Neurosurgery, Roma, Italy
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Franco Caputi
- San Filippo Neri Hospital, Department of Neurosurgery, Roma, Italy
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Raffaele Roperto
- San Filippo Neri Hospital, Department of Neurosurgery, Roma, Italy
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Maria Pia Tonelli
- San Filippo Neri Hospital, Department of Neurosurgery, Roma, Italy
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Ettore Carpineta
- San Filippo Neri Hospital, Department of Neurosurgery, Roma, Italy
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Takanori Fukushima
- Carolina Neuroscience Institute, Raleigh, North Carolina, USA
| Published: | June 2, 2015 |
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Outline
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Objective: CSF leakages represent a major complication of posterior cranial fossa and skull base intradural surgery. Watertight dural suture is the challenging step and different products to reinforce the dural repair have been proposed. During the last 6 months, we changed our previous way of dural closure in patients who underwent retrosigmoid approach surgeries, using a locally harvested autologous pericranium graft as dural substitute.
Method: This is a retrospective analysis of 27 patients operated on for a posterior fossa craniotomy between March and August 2014. All patients received locally harvested autologous pericranium for duraplasty, inserted as an underlay "hourglass-shaped" plug under the dura plane and stitched from outside to inside to the dura mater. The autologous patch has been augmented with a sealant. The possible complications considered were: new neurological symptoms related to the technique, surgical site infections, meningitis, cerebrospinal fluid (CSF) leaks, formation of pseudomeningocele (on postoperative MRI and/or CT scan).
Results: Indications for posterior fossa surgery included: tumor in 16 cases (12 acoustic neuromas and 4 cerebello-pontine angle meningiomas), microvascular decompression for irritative 5th or 7th cranial nerve syndrome in 10, and hemorrhagic cerebellar AVM in 1 case. Surgical site infections, meningitis, and CSF leaks have never been observed. The complication rate was 4%: 1 NF2 patient operated on for a right large acoustic neuroma developed an asymptomatic small pseudomeningocele on the 48-hour-postoperative CT scan, disappeared on the 3-month MRI follow-up.
Conclusions: In our small series, autologous pericranium inserted and stitched as an underlay hourglass-shaped plug followed by dural sealant augmentation, seemed to be a safe and effective way to repair the dural opening in posterior fossa surgeries. With this technique we observed a lower complication rate in comparison to our previous systems of closure and to the data of the available literature.
