Factors associated with cerebrospinal fluid leak after a retrosigmoid approach for cerebellopontine angle surgery

Nicola Montano, Francesco Signorelli, Marco Giordano, Federica Ginevra D'Onofrio, Alessandro Izzo, Manuela D'Ercole, Eleonora Ioannoni, Giovanni Pennisi, Anselmo Caricato, Roberto Pallini, Alessandro Olivi

Risultato della ricerca: Contributo in rivistaArticolo in rivista


Background: The retrosigmoid approach represents a crucial surgical route to address different lesions in the cerebellopontine angle but cerebrospinal fluid (CSF) leak still remains the most frequent complication after this approach. Here, we analyzed the impact of different factors in CSF leak development after a retrosigmoid approach. Identifying risk factors related to a specific approach may help the surgeon to tailor the perioperative management and to appropriately counsel patients regarding their risk profile. Methods: We retrospectively reviewed the clinical, surgical, and outcome data of 103 consecutive patients (M/F, 47/56; mean follow-up 35.6 ± 23.9 months) who underwent a retrosigmoid approach for different cerebellopontine angle pathologies and studied the impact of different factors on the occurrence of a CSF leak to univariate and multivariate analysis. Results: Seventy-nine patients (76.7%) were operated for tumors growing in the cerebellopontine angle. Twenty-four patients (23.2%) underwent microvascular decompression to treat a drug-resistant trigeminal neuralgia. Sixteen patients (15.5%) developed CSF leak in the postoperative course of which six underwent surgical revision. Performing a craniectomy as surgical procedure (P = 0.0450) and performing a reopening procedure (second surgery; P = 0.0079) were significantly associated to a higher risk of developing CSF leak. Moreover, performing a reopening procedure emerged as an independent factor for CSF developing on multivariate analysis (P = 0.0156). Conclusion: Patients submitted to craniectomy and patients who underwent a second surgery showed an higher CSF leak rate. Ongoing improvement of biomaterial technology may help neurosurgeons to prevent this potentially life-threatening complication.
Lingua originaleEnglish
pagine (da-a)258-259
Numero di pagine2
RivistaSurgical Neurology International
Stato di pubblicazionePubblicato - 2021


  • Cerebrospinal fluid leak
  • Craniectomy
  • Craniotomy
  • Neurovascular conflict
  • Retrosigmoid approach
  • Vestibular schwannoma


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