Microplate-Bridge Technique for Watertight Dural Closures in the Combined Petrosal Approach

Abstract

Although the combined petrosal approach has significant advantages for medium to large petroclival lesions, it carries the risk of a few major complications. The cerebrospinal fluid leak rate with this approach has been reported to be as high as 15%. To describe an innovative technique of watertight dural closure with a long microplate-bridge technique for the combined petrosal approach. We describe our method of watertight dural closures with the microplate-bridge technique for combined petrosal approaches using cadaveric heads and clinical cases. We review our postoperative outcomes in respect to cerebrospinal fluid leaks. The technique involves a fascial graft to the presigmoid-subtemporal defect, fixated with a long microtitanium plate over the cranial base side. The fascial graft is augmented by covering it with an abdominal fat graft and a vascularized pericranial flap. This technique was performed in 23 patients after surgical resection of petroclival meningiomas with only 1 postoperative cerebrospinal fluid leak (4.4%). We recommend this safe and simple closure technique during skull base surgery.