{"id":"291d625b-5452-4a22-bcc0-e49452c83796","slug":"underlay-hourglass-shaped-autologous-pericranium-duraplasty-in-key-hole-retrosigmoid-approach-surgery-technical-report","title":"Underlay hourglass-shaped autologous pericranium duraplasty in “key-hole” retrosigmoid approach surgery: Technical report","authors":["Luciano Mastronardi","Guglielmo Cacciotti","Franco Caputi","Raffaelino Roperto","Maria Pia Tonelli","Ettore Carpineta","Takanori Fukushima"],"abstract":"Background: Cerebrospinal fluid (CSF) leakages represent a major complication of skull base surgery. Watertight dural suture is challenging, and different ways to reinforce it have been proposed. Since 6 months, we use locally harvested autologous pericranium graft for dural repair in retrosigmoid approach. Methods: Retrospectively, we analyzed 27 patients operated on with key-hole retrosigmoid approach from May 2014. In all, autologous pericranium was harvested and inserted as an underlay “hourglass-shaped” plug under the dura plane and stitched to dura. Surgical patch and sealant were used for augmentation. Complications considered were new neurological symptoms, surgical site infections, meningitis, CSF-leaks, and pseudomeningocele. Results: Indications included tumor (16 cases), microvascular decompression (10 cases), and hemorrhagic cerebellar arteriovenous malformation (1 case). Surgical site infections, meningitis, and CSF leaks have never been observed. One neurofibromatosis type 2 patient operated on for large acoustic neuroma developed an asymptomatic pseudomeningocele, disappeared on 3-month magnetic resonance imaging follow-up. Conclusions: In our series, autologous pericranium inserted and stitched as an underlay hourglass-shaped plug, augmented with surgical patch pieces and dural sealant seemed to be safe and effective for dural repair in “key-hole” retrosigmoid approach. With this technique, we obtained low complication rate, similar to the best current results of available literature.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/291d625b-5452-4a22-bcc0-e49452c83796/featured/hero-1782420936247.png","publishDate":"2016-03-10T00:00:00.000Z","doi":"10.4103/2152-7806.178521","categories":["Technical Note"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2016/03/6645/SNI-7-25.pdf"}