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Ahmed Ansari, Raman Mohan Sharma, Mohd Tabish Khan, M. Fakhrul Huda
  1. Department of Neurosurgery, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India.

Correspondence Address:
Ahmed Ansari, Department of Neurosurgery, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, India.

DOI:10.25259/SNI_631_2021

Copyright: © 2022 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, transform, 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: Ansari A, Sharma RM, Khan MT, Huda MF. Factors associated with cerebrospinal fluid leak after retrosigmoid approach. Surg Neurol Int 10-Jun-2022;13:240

How to cite this URL: Ansari A, Sharma RM, Khan MT, Huda MF. Factors associated with cerebrospinal fluid leak after retrosigmoid approach. Surg Neurol Int 10-Jun-2022;13:240. Available from: https://surgicalneurologyint.com/surgicalint-articles/11651/

Date of Submission
24-Jun-2021

Date of Acceptance
15-Apr-2022

Date of Web Publication
10-Jun-2022

Dear Editor,

We read with great interest the article by Montano et al.[ 1 ] on the factors associated with cerebrospinal fluid (CSF) leak after a retrosigmoid approach for cerebellopontine angle surgery. The authors have rightly pointed out that performing a craniectomy and a reopening procedure as significantly associated with a higher risk of CSF leak.

However, we do believe that one of the most consistent contributors in CSF leak following retrosigmoid approach is the opening method and closure of fascia following surgery. We perform a Y-shaped opening of the fascia, with the two limbs of Y-above the transverse sinus, which is not reflected from the bone. At the time of closure, both the limbs are approximated together with the vertical limb of Y-giving it a further tight sealant effect [ Figure 1 ]. Of course, postoperative hydrocephalus and a nonwatertight dural closure are the other reasons for CSF leak post retrosigmoid surgery.


Figure 1:

Fascia is incised in a Y-shaped fashion with its limbs overlying the sinus, and is stitched back in a water tight fashion.

 

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1. Montano N, Signorelli F, Giordano M, D’Onofrio FG, Izzo A, D’Ercole M. Factors associated with cerebrospinal fluid leak after a retrosigmoid approach for cerebellopontine angle surgery. Surg Neurol Int. 2021. 12: 258

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