How to Eradicate CSF Leak in the Postoperative Course of Vestibular Schwannoma, Exclusively Using Transpetrosal Approaches

Abstract

Objective: To report eradication of postoperative meningitis and cerebrospinal fluid (CSF) leak after vestibular schwannoma (VS) surgery. Methods: We analyzed a series of 400 consecutive patients who underwent surgical removal of VS via transpetrosal approaches (translabyrinthine approach [TLA] or widened retrolabyrinthine approaches [WRLA]). At the time of closing the surgical approach, all opened mastoid air cells surrounding the internal auditory meatus were filled with bone wax. In WRLA, the middle ear was preserved and the aditus blocked by a single thick piece of bone wax. In TLA, the eustachian tube was tightly closed through the epitympanum with several small pieces of the same material after incus removal. In both, fibrin glue was used to stabilize the fat graft and prevent CSF leakage. This graft consisted of two separate pieces of fat and secured with glue, before wound closure. Results: There were 191 men and 209 women. Mean age was 51.9 years (range, 11-80 years). Tumor size was Koos stage 1 in 35 cases, stage 2 in 128 cases, stage 3 in 84 cases, and stage 4 in 153. TLA was used in 281 patients and WRLA in 119 cases. Mortality was absent. No patient had a CSF fistula. Only one case of meningitis was observed, following a wound abscess. Conclusion: We have observed that postoperative complications related to the CSF fistulas were not a fatality and could be avoided in transpetrosal approaches with a very simple but cautions technique of closure.