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J Neurol Surg B Skull Base 2021; 82(06): 695-699
DOI: 10.1055/s-0040-1713772
Original Article

Comparison of Small Intestinal Submucosal Graft and Autologous Tissue in Prevention of CSF leak after Posterior Fossa Craniotomy

Douglas J. Totten
1   Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
Nauman F. Manzoor
2   Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Kristen L. Yancey
2   Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Robert J. Yawn
2   Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
David S. Haynes
2   Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Alejandro Rivas
2   Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
› Institutsangaben Funding No funding or other support was provided for this study.
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Abstract

Objective To compare the use of porcine small intestinal submucosal grafts (SISG) and standard autologous material (fascia) in prevention of cerebrospinal fluid (CSF) leak and pseudomeningocele formation after translabyrinthine resection.

Setting Set at the tertiary skull base center.

Methods This is a retrospective chart review. After Institutional Review Board approval, we performed a retrospective cohort study evaluating CSF leak in patients who underwent resection of lateral skull base defects with multilayered reconstruction using either fascia autograft or porcine SISGs. Demographics were summarized with descriptive statistics. Logistic regression was used to compare autograft and xenograft cohorts in terms of CSF complications.

Results Seventy-seven patients underwent lateral skull base resection, followed by reconstruction of the posterior cranial fossa. Of these patients, 21 (27.3%) underwent multilayer repair using SISG xenograft. There were no significant differences in leak-associated complications between autograft and xenograft cohorts. Ventriculoperitoneal shunt was necessary in one (1.8%) autograft and one (4.8) xenograft cases (p = 0.49). Operative repair to revise surgical defect was necessary in three (5.4%) autograft cases and none in xenograft cases.

Conclusion The use of SISG as a component of complex skull base reconstruction after translabyrinthine tumor resection may help reduce CSF leak rates and need for further intervention.

Keywords

submucosal graft - xenograft - cerebrospinal fluid leak - craniotomy

Institutional Review Board Approval

Vanderbilt University IRB Approval 181441.




Publikationsverlauf

Eingereicht: 10. Dezember 2019

Angenommen: 27. April 2020

Artikel online veröffentlicht:
12. März 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Lindberg K, Badylak SF. Porcine small intestinal submucosa (SIS): a bioscaffold supporting in vitro primary human epidermal cell differentiation and synthesis of basement membrane proteins. Burns 2001; 27 (03) 254-266
    CrossrefPubMedGoogle Scholar
  • 2 Hodde JP, Badylak SF, Brightman AO, Voytik-Harbin SL. Glycosaminoglycan content of small intestinal submucosa: a bioscaffold for tissue replacement. Tissue Eng 1996; 2 (03) 209-217
    CrossrefPubMedGoogle Scholar
  • 3 Illing E, Chaaban MR, Riley KO, Woodworth BA. Porcine small intestine submucosal graft for endoscopic skull base reconstruction. Int Forum Allergy Rhinol 2013; 3 (11) 928-932
    CrossrefPubMedGoogle Scholar
  • 4 Mangham CA. Complications of translabyrinthine vs. suboccipital approach for acoustic tumor surgery. Otolaryngol Head Neck Surg 1988; 99 (04) 396-400
    CrossrefPubMedGoogle Scholar
  • 5 Fishman AJ, Hoffman RA, Roland Jr JT, Lebowitz RA, Cohen NL. Cerebrospinal fluid drainage in the management of CSF leak following acoustic neuroma surgery. Laryngoscope 1996; 106 (08) 1002-1004
    CrossrefPubMedGoogle Scholar
  • 6 Fishman AJ, Marrinan MS, Golfinos JG, Cohen NL, Roland Jr JT. Prevention and management of cerebrospinal fluid leak following vestibular schwannoma surgery. Laryngoscope 2004; 114 (03) 501-505
    CrossrefPubMedGoogle Scholar
  • 7 Goddard JC, Oliver ER, Lambert PR. Prevention of cerebrospinal fluid leak after translabyrinthine resection of vestibular schwannoma. Otol Neurotol 2010; 31 (03) 473-477
    CrossrefPubMedGoogle Scholar
  • 8 Brennan JW, Rowed DW, Nedzelski JM, Chen JM. Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach on incidence and response to treatment. J Neurosurg 2001; 94 (02) 217-223
    CrossrefPubMedGoogle Scholar
  • 9 Charpiot A, Tringali S, Zaouche S, Ferber-Viart C, Dubreuil C. Perioperative complications after translabyrinthine removal of large or giant vestibular schwannoma: outcomes for 123 patients. Acta Otolaryngol 2010; 130 (11) 1249-1255
    CrossrefPubMedGoogle Scholar
  • 10 Merkus P, Taibah A, Sequino G, Sanna M. Less than 1% cerebrospinal fluid leakage in 1,803 translabyrinthine vestibular schwannoma surgery cases. Otol Neurotol 2010; 31 (02) 276-283
    CrossrefPubMedGoogle Scholar
  • 11 Shea MC, Robertson JT. Acoustic neuroma removal: a comparative study of translabyrinthine and suboccipital approaches. Am J Otol 1979; 1 (02) 94-99
    PubMedGoogle Scholar
  • 12 Becker SS, Jackler RK, Pitts LH. Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches. Otol Neurotol 2003; 24 (01) 107-112
    CrossrefPubMedGoogle Scholar
  • 13 Falcioni M, Mulder JJ, Taibah A, De Donato G, Sanna M. No cerebrospinal fluid leaks in translabyrinthine vestibular schwannoma removal: reappraisal of 200 consecutive patients. Am J Otol 1999; 20 (05) 660-666
    PubMedGoogle Scholar
  • 14 Peng KA, Chen BS, Lorenz MB. et al. Revision surgery for vestibular schwannomas. J Neurol Surg B Skull Base 2018; 79 (06) 528-532
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 15 Russel A, Hoffmann CP, Nguyen DT, Beurton R, Parietti-Winkler C. Can the risks of cerebrospinal fluid leak after vestibular schwannoma surgery be predicted?. Otol Neurotol 2017; 38 (02) 248-252
    CrossrefPubMedGoogle Scholar
  • 16 Stieglitz LH, Giordano M, Gerganov V. et al. Petrous bone pneumatization is a risk factor for cerebrospinal fluid fistula following vestibular schwannoma surgery. Neurosurgery 2010; 67 (02) , Suppl Operative ): 509-515
    PubMedGoogle Scholar
  • 17 Murphy ME, McCutcheon BA, Kerezoudis P. et al. Morbid obesity increases risk of morbidity and reoperation in resection of benign cranial nerve neoplasms. Clin Neurol Neurosurg 2016; 148: 105-109
    CrossrefPubMedGoogle Scholar
  • 18 Chern A, Hunter JB, Bennett ML. Cost analysis of cerebrospinal fluid leaks and cerebrospinal fluid leak prevention in patients undergoing cerebellopontine angle surgery. Otol Neurotol 2017; 38 (01) 147-151
    CrossrefPubMedGoogle Scholar
  • 19 Hunter JB, Sweeney AD, Carlson ML. et al. Prevention of postoperative cerebrospinal fluid leaks after translabyrinthine tumor resection with resorbable mesh cranioplasty. Otol Neurotol 2015; 36 (09) 1537-1542
    CrossrefPubMedGoogle Scholar
  • 20 Oakley GM, Christensen JM, Winder M. et al. Collagen matrix as an inlay in endoscopic skull base reconstruction. J Laryngol Otol 2018; 132 (03) 214-223
    CrossrefPubMedGoogle Scholar
  • 21 Cueva RA, Mastrodimos B. Approach design and closure techniques to minimize cerebrospinal fluid leak after cerebellopontine angle tumor surgery. Otol Neurotol 2005; 26 (06) 1176-1181
    CrossrefPubMedGoogle Scholar
  • 22 Phillips J, Riley KO, Woodworth BA. Porcine small intestine submucosal grafts for post-tumor resection orbital reconstruction. Laryngoscope 2014; 124 (06) E219-E223
    CrossrefPubMedGoogle Scholar
  • 23 Yoo F, Wang MB, Bergsneider M, Suh JD. Single layer repair of large anterior skull base defects without vascularized mucosal flap. J Neurol Surg B Skull Base 2017; 78 (02) 139-144
    PubMedGoogle Scholar
  • 24 Witt RG, Raff G, Van Gundy J, Rodgers-Ohlau M, Si MS. Short-term experience of porcine small intestinal submucosa patches in paediatric cardiovascular surgery. Eur J Cardiothorac Surg 2013; 44 (01) 72-76
    CrossrefPubMedGoogle Scholar
  • 25 Madhu C, Cooke J, Harber P, Holmes D. Functional outcomes of posterior vaginal wall repair and prespinous colpopexy with biological small intestinal submucosal (SIS) graft. Arch Gynecol Obstet 2014; 290 (04) 711-716
    CrossrefPubMedGoogle Scholar
  • 26 Staerman F, Pierrevelcin J, Ripert T, Menard J. Medium-term follow-up of plaque incision and porcine small intestinal submucosal grafting for Peyronie's disease. Int J Impot Res 2010; 22 (06) 343-348
    CrossrefPubMedGoogle Scholar
  • 27 Farahat YA, Elbahnasy AM, El-Gamal OM, Ramadan AR, El-Abd SA, Taha MR. Endoscopic urethroplasty using small intestinal submucosal patch in cases of recurrent urethral stricture: a preliminary study. J Endourol 2009; 23 (12) 2001-2005
    CrossrefPubMedGoogle Scholar
  • 28 Knoll LD. Use of porcine small intestinal submucosal graft in the surgical management of tunical deficiencies with penile prosthetic surgery. Urology 2002; 59 (05) 758-761
    CrossrefPubMedGoogle Scholar
  • 29 Bejjani GK, Zabramski J. Durasis Study Group. Safety and efficacy of the porcine small intestinal submucosa dural substitute: results of a prospective multicenter study and literature review. J Neurosurg 2007; 106 (06) 1028-1033
    CrossrefPubMedGoogle Scholar
  • 30 Yawn RJ, Dedmon MM, O'Connell BP, Virgin FW, Rivas A. Tympanic membrane perforation repair using porcine small intestinal submucosal grafting. Otol Neurotol 2018; 39 (05) e332-e335
    CrossrefPubMedGoogle Scholar
  • 31 Nayak JV, Rathor A, Grayson JW. et al. Porcine small intestine submucosal grafts improve remucosalization and progenitor cell recruitment to sites of upper airway tissue remodeling. Int Forum Allergy Rhinol 2018; 8 (10) 1162-1168
    CrossrefPubMedGoogle Scholar
  • 32 Mangus BD, Rivas A, Yoo MJ. et al. Management of cerebrospinal fluid leaks after vestibular schwannoma surgery. Otol Neurotol 2011; 32 (09) 1525-1529
    CrossrefPubMedGoogle Scholar
  • 33 Selesnick SH, Liu JC, Jen A, Newman J. The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery. Otol Neurotol 2004; 25 (03) 387-393
    CrossrefPubMedGoogle Scholar