gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Correlation between pneumatisation of the petrous bone and CSF fistula in the retrosigmoid approach for vestibular schwannoma surgery

Meeting Abstract

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  • Kristofer Ramina - Neurochirurgische Klinik, Universitätsklinikum Tübingen, Tübingen
  • Florian Ebner - Neurochirurgische Klinik, Universitätsklinikum Tübingen, Tübingen
  • Marcos Tatagiba - Neurochirurgische Klinik, Universitätsklinikum Tübingen, Tübingen

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.10.05

doi: 10.3205/13dgnc361, urn:nbn:de:0183-13dgnc3618

Published: May 21, 2013

© 2013 Ramina et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: to correlate the risk of CSF Fistula with the extension of the petrous bone pneumatisation for the retrosigmoid approach and opening of the intern auditory canal.

Method: 140 patients submitted to resection of a vestibular schwannoma by a retrosigmoid approach were evaluated regarding the extension of the petrous bone pneumatisation and incidence of CSF Fistula. The evaluation was performed comparing the pneumatisation of the pre-operative thin sliced CT-scans with the opening of the air cells in the post-operative thin sliced CT-Scans and the clinical outcome.

Results: the CSF Fistula and its consequences for the clinical outcome and the length of the hospital stay in the vestibular schwannoma surgery represents a big issue for the surgeon and the patient. To achieve a complete resection of the tumor it is necessary to open the intern auditory canal during the surgery and consequently if the temporal bone is pneumatisated it represents a higher risk of a CSF-Fistula. Despite the obvious risk this issue was never studied in detail. We evaluated if the risk of a CSF-Fistula in patients in which the penumatisated intern auditory canal was opened during surgery correlates with the actual higher incidence of a CSF-Fistula. The incidence of CSF-Fistula was 12 %. From the patients with CSF-Fistula 80 % had a pneumatisated intern auditory canal witch was opened during surgery proving that the risk of CSF-Fistula is actually higher in patients in whom the intern auditory canal is pneumatisated.

Conclusions: the pre-operative evaluation of the pneumatisation of the temporal bone, specially the intern auditory canal, is essential for the surgeon to reduce the risk of a CSF-Fistula complication, thus the risk of a CSF-Fistula is 66 % higher when the petrous bone is pneumatisated.