Double Plombage Using Abdominal Adipose Tissue for Posterior Transpetrosal Approach–induced Liquorrhea

Abstract

Objective: To prevent posterior transpetrosal approach–induced liquorrhea, we developed a method involving the double application of abdominal adipose tissue in the subdural and epidural spaces. Materials and Methods: The method was applied to 8 patients who underwent surgery under a posterior transpetrosal approach: 4 with petroclival meningioma and 1 each with tentorial meningioma, jugular foramen neurinoma, trigeminal neurinoma, and metastatic brain tumor. The combined transpetrosal approach was used for 6 patients and the combination with the lateral suboccipital approach was used for the other 2 patients. After tumor resection, the divided dura mater of the presigmoid space was closed as follows: first, a fat mass excised from the abdominal region was divided into 2 parts, and several excisions were made in each part to flatten them. The exposed brain surface was covered with the flattened fat, and the fat margin was circumferentially inserted under the dura mater. The division was then closed by suturing the dural stumps at several sites, loading tension to some extent. Finally, the other part of the adipose tissue was spread in the epidural space in the dural-defective region for double closure inside and outside the dura mater. Results: Liquorrhea was prevented in all patients. Conclusions: It was concluded that this method is useful to prevent postoperative liquorrhea induced by a posterior transpetrosal approach.