Factors associated with cerebrospinal fluid leak after a retrosigmoid approach for cerebellopontine angle surgery
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Neurosurgical Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Nicola Montano, Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
DOI:10.25259/SNI_42_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Nicola Montano1, Francesco Signorelli1, Martina Giordano1, Ginevra Federica D’Onofrio1, Alessandro Izzo1, Manuela D’Ercole1, Eleonora Ioannoni2, Giovanni Pennisi1, Anselmo Caricato2, Roberto Pallini1, Alessandro Olivi1. Factors associated with cerebrospinal fluid leak after a retrosigmoid approach for cerebellopontine angle surgery. 07-Jun-2021;12:258
How to cite this URL: Nicola Montano1, Francesco Signorelli1, Martina Giordano1, Ginevra Federica D’Onofrio1, Alessandro Izzo1, Manuela D’Ercole1, Eleonora Ioannoni2, Giovanni Pennisi1, Anselmo Caricato2, Roberto Pallini1, Alessandro Olivi1. Factors associated with cerebrospinal fluid leak after a retrosigmoid approach for cerebellopontine angle surgery. 07-Jun-2021;12:258. Available from: https://surgicalneurologyint.com/surgicalint-articles/factors-associated-with-cerebrospinal-fluid-leak-after-a-retrosigmoid-approach-for-cerebellopontine-angle-surgery/
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.
Keywords: Craniotomy, Cerebrospinal fluid leak, Craniectomy, Neurovascular conflict, Retrosigmoid approach, Vestibular schwannoma
The retrosigmoid approach represents an excellent surgical route to address various tumors and vascular lesions in the cerebellopontine angle.[
We retrospectively reviewed the clinical, surgical and outcome data of 103 consecutive patients (M/F, 47/56) who underwent a retrosigmoid approach for cerebellopontine angle pathologies between February 2013 and December 2019 at our department. The mean age was 53.6 ± 15.4 years and the mean follow-up was 35.6 ± 23.9 months. We studied the role of factors such as age, sex, the type of pathology, the evidence of preoperative and postoperative hydrocephalus, and the type of surgical procedure (craniotomy/craniectomy) or if the procedure was a reopening (second surgery), the cisterna magna opening during surgery, the use of dural suture, dural patch, fibrin glue, and other dural sealants during surgery on the occurrence of a CSF leak (subcutaneous collection, incisional leak, CSF rhinorrhea, and CSF otorrhea) in the postoperative course of these patients. The surgical procedures were performed by different neurosurgeons thus the closure techniques varied according to the surgeon’s preference. The dura was sutured either with a 3–0 silk suture (40 cases) or with a 4–0 nylon suture (58 cases). An artificial dural substitute was used in all cases of dural patch (77 cases). For patients in whom CSF leak occurred, the type of treatment was also recorded. Statistical comparison of categorical variables was performed by χ2 statistic, using the Fisher exact test. A multivariate logistic regression model was used to estimate the odds ratio of developing a CSF leak, while adjusting for baseline variables. Differences were considered significant at P < 0.05. Statistical analyses were done using StatView version 5 software (SAS Institute Inc.).
Data of patients are summarized in
The retrosigmoid approach to the cerebellopontine angle, first popularized in the 1930s by Dandy,[
Our study has some limitations due to the retrospective nature of data. For this reason, we were not able to study the impact of body mass index which might affect the complication rate in this type of surgery.[
In our study, we identified subgroups of patients who were at risk for CSF leak occurrence after a retrosigmoid approach for the treatment of different pathologies. Patients submitted to craniectomy and patients who underwent a second surgery showed an higher CSF leak rate. Ongoing improvement of biomaterial technology[
Patient’s consent not required as patients identity is not disclosed or compromised.
There are no conflicts of interest.
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