TY - JOUR
T1 - Dural and cranial reconstruction techniques in retrosigmoid craniotomy: key factors associated with CSF leaks in 225 patients
AU - Auricchio, Anna Maria
AU - Martinelli, Renata
AU - Offi, Martina
AU - Nichelatti, Michele
AU - Valeri, Federico
AU - Rapisarda, Alessandro
AU - Di Domenico, Michele
AU - Montano, Nicola
AU - Olivi, Alessandro
AU - Della Pepa, Giuseppe Maria
PY - 2025
Y1 - 2025
N2 - OBJECTIVE This study evaluated the effectiveness of various dural closure and bone reconstruction techniques in preventing CSF leakage following retrosigmoid craniotomy for cerebellopontine angle (CPA) tumors. The goal was to identify whether newer combinations of reconstructive materials offer any advantage in reducing CSF leaks and improv- ing surgical outcomes. METHODS The authors conducted a retrospective review of 225 patients who underwent a retrosigmoid craniotomy for CPA neoplasms between January 2018 and August 2024. Patient demographics, intraoperative reports, and postopera- tive complications were analyzed. Various reconstructive methods, including the use of TachoSil, HydroSet, autologous or heterologous dural patches, and bone flap repositioning, were compared. CSF-related complications such as CSF leakage, infections, and postoperative hydrocephalus were systematically evaluated. RESULTS CSF leakage occurred in 31% of cases (n = 69), while CSF infections and postoperative hydrocephalus were noted in 6% and 7% of patients, respectively. HydroSet combined with bone flap repositioning significantly reduced CSF leakage (p = 0.008), as did the combination of HydroSet and heterologous dural patches (p = 0.007). TachoSil did not show a significant reduction in CSF leakage. Craniectomy with titanium mesh or heterologous cranioplasty was not as- sociated with any CSF leaks. No other single or combined techniques showed significant associations with CSF leakage. CONCLUSIONS HydroSet in combination with bone reconstruction and heterologous patches demonstrated superior outcomes in reducing CSF leaks. TachoSil did not significantly affect leakage rates, with less definite results. Refining surgical techniques and selecting appropriate materials for dural and bone reconstruction may help reduce complica- tions and improve patient outcomes in CPA tumor surgeries using the retrosigmoid approach.https://thejns.org/doi/abs/10.3171/2024.11.FOCUS24681
AB - OBJECTIVE This study evaluated the effectiveness of various dural closure and bone reconstruction techniques in preventing CSF leakage following retrosigmoid craniotomy for cerebellopontine angle (CPA) tumors. The goal was to identify whether newer combinations of reconstructive materials offer any advantage in reducing CSF leaks and improv- ing surgical outcomes. METHODS The authors conducted a retrospective review of 225 patients who underwent a retrosigmoid craniotomy for CPA neoplasms between January 2018 and August 2024. Patient demographics, intraoperative reports, and postopera- tive complications were analyzed. Various reconstructive methods, including the use of TachoSil, HydroSet, autologous or heterologous dural patches, and bone flap repositioning, were compared. CSF-related complications such as CSF leakage, infections, and postoperative hydrocephalus were systematically evaluated. RESULTS CSF leakage occurred in 31% of cases (n = 69), while CSF infections and postoperative hydrocephalus were noted in 6% and 7% of patients, respectively. HydroSet combined with bone flap repositioning significantly reduced CSF leakage (p = 0.008), as did the combination of HydroSet and heterologous dural patches (p = 0.007). TachoSil did not show a significant reduction in CSF leakage. Craniectomy with titanium mesh or heterologous cranioplasty was not as- sociated with any CSF leaks. No other single or combined techniques showed significant associations with CSF leakage. CONCLUSIONS HydroSet in combination with bone reconstruction and heterologous patches demonstrated superior outcomes in reducing CSF leaks. TachoSil did not significantly affect leakage rates, with less definite results. Refining surgical techniques and selecting appropriate materials for dural and bone reconstruction may help reduce complica- tions and improve patient outcomes in CPA tumor surgeries using the retrosigmoid approach.https://thejns.org/doi/abs/10.3171/2024.11.FOCUS24681
KW - CSF leak
KW - bone reconstruction
KW - cerebellopontine neoplasm
KW - dural sealant
KW - retrosigmoid approach
KW - CSF leak
KW - bone reconstruction
KW - cerebellopontine neoplasm
KW - dural sealant
KW - retrosigmoid approach
UR - https://publicatt.unicatt.it/handle/10807/316379
UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=85217117794&origin=inward
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85217117794&origin=inward
U2 - 10.3171/2024.11.FOCUS24681
DO - 10.3171/2024.11.FOCUS24681
M3 - Article
SN - 1092-0684
VL - 58
SP - 1
EP - 7
JO - Neurosurgical Focus
JF - Neurosurgical Focus
IS - 2
ER -
