Sandwich Wound Closure Reduces the Risk of Cerebrospinal Fluid Leaks in Posterior Fossa Surgery

Verena Heymanns,Homajoun Maslehaty,Richard Parvin,Athanasios K Petridis,Martin Scholz,Abidemi W Oseni,Ameer Alyeldien

doi:10.4081/cp.2016.824

Abstract

Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.

Highlights

The present study aims to s introduce a sandwich closure of the dura in u posterior fossa surgery, which reduces signifil cantly the number of cerebrospinal fluid (CSF) leaks (3.8%) in the ia patients treated in our department
This study presents our experience with the Sandwich technique of dural closure using a combination of autologous dura, dural substitute and fibrin glue
All other pathologies were represented by numsecond surgery for CSF leakage closure

Summary

Introduction

After removing the pathology in the posterior fossa, dural closure follows a sandwich closure with lyophilized dura, which is sutured on the dural edges, suturing the dura pared to the general population. 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Dura closure is a very important last step in coated watertight sealant over the dura and leaking outside the wound or not. Two perthe performance of the posterior fossa under the edges of the craniotomy. In a cent had a cerebellar bleeding with no need approach. Primary dural closure is often tech- step the bone is replaced with polymethyl- for re-operation and 3% had a wound infecnically difficult and requires use of substi- methacrylate, which is fixed as shown in tion treated with antibiotics

Methods

Results

Conclusion