A Multilayered Technique for Repair of the Suboccipital Retrosigmoid Craniotomy

Abstract

Objective Our primary objective was to retrospectively review our single institution experience using an anatomic multilayered repair of the retrosigmoid suboccipital craniotomy. Our secondary objective was to review the existing body of literature on the repair of this craniotomy and compare our outcomes to previous results.

Design Retrospective review of 25 consecutive patients undergoing repair for the retrosigmoid craniotomy.

Setting University of California Davis Medical Center (2010–2016).

Participants A total of 25 consecutive patients who underwent retrosigmoid craniotomy and repair. Exclusion criteria included patients who were under the age of 18 years.

Main Outcome Measures Main outcomes included incidence of postoperative headache, cerebrospinal fluid leak, and wound infections.

Results Postoperative headache was reported in two patients in this series (8%). None of the patients in the series developed cerebrospinal fluid leak or wound infections. Mean follow-up period was 16 months.

Conclusion Our multilayered anatomic repair after retrosigmoid suboccipital craniotomy results in favorable clinical results and may help reduce the risks associated with this operation.

Keywords

retrosigmoid craniotomy - cranioplasty - CSF leak - headache - repair - skull base - gasket seal

Note

The contents of this manuscript have been submitted for consideration as an electronic poster to the North American Skull Base Society conference to be held on February 14, 2018 in Coronado, California.

• References

• 1 Schaller B, Heilbronner R, Pfaltz CR, Probst RR, Gratzl O. Preoperative and postoperative auditory and facial nerve function in cerebellopontine angle meningiomas. Otolaryngol Head Neck Surg 1995; 112 (02) 228-234
• 2 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
• 3 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve--preservation and restitution of function. Neurosurgery 1997; 40 (04) 684-694 , discussion 694–695
• 4 Samii M, Gerganov V, Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg 2006; 105 (04) 527-535
• 5 Ansari SF, Terry C, Cohen-Gadol AA. Surgery for vestibular schwannomas: a systematic review of complications by approach. Neurosurg Focus 2012; 33 (03) E14
• 6 Abolfotoh M, Dunn IF, Al-Mefty O. Transmastoid retrosigmoid approach to the cerebellopontine angle: surgical technique. Neurosurgery 2013; 73 (1, Suppl Operative) ons16-ons23 , discussion ons23
• 7 Richmon JD, Yarlagadda BB, Wax MK, Patel U, Diaz J, Lin DT. Locoregional and free flap reconstruction of the lateral skull base. Head Neck 2015; 37 (09) 1387-1391
• 8 Cardoso AC, Fernandes YB, Ramina R, Borges G. Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position. Arq Neuropsiquiatr 2007; 65 (3A, 3a): 605-609
• 9 Garcia-Navarro V, Anand VK, Schwartz TH. Gasket seal closure for extended endonasal endoscopic skull base surgery: efficacy in a large case series. World Neurosurg 2013; 80 (05) 563-568
• 10 Schaller B, Baumann A. Headache after removal of vestibular schwannoma via the retrosigmoid approach: a long-term follow-up-study. Otolaryngol Head Neck Surg 2003; 128 (03) 387-395
• 11 Ling PY, Mendelson ZS, Reddy RK, Jyung RW, Liu JK. Reconstruction after retrosigmoid approaches using autologous fat graft-assisted Medpor Titan cranioplasty: assessment of postoperative cerebrospinal fluid leaks and headaches in 60 cases. Acta Neurochir (Wien) 2014; 156 (10) 1879-1888
• 12 Bryce GE, Nedzelski JM, Rowed DW, Rappaport JM. Cerebrospinal fluid leaks and meningitis in acoustic neuroma surgery. Otolaryngol Head Neck Surg 1991; 104 (01) 81-87
• 13 Harner SG, Beatty CW, Ebersold MJ. Headache after acoustic neuroma excision. Am J Otol 1993; 14 (06) 552-555
• 14 Jackson CG, McGrew BM, Forest JA. , et al. Comparison of postoperative headache after retrosigmoid approach: vestibular nerve section versus vestibular schwannoma resection. Am J Otol 2000; 21 (03) 412-416
• 15 Koperer H, Deinsberger W, Jödicke A, Böker DK. Postoperative headache after the lateral suboccipital approach: craniotomy versus craniectomy. Minim Invasive Neurosurg 1999; 42 (04) 175-178
• 16 Ln S, Wb G, Dc W. The best treatment for vestibular schwannoma (acoustic neuroma): microsurgery or radiosurgery?. Am J Otol 1996; 17 (04) 676-682