Bone Cement Cranioplasty Reduces Cerebrospinal Fluid Leak Rate after Microvascular Decompression: A Single-Institutional Experience

Abstract

Background Microvascular decompression (MVD) is a common surgical treatment for cranial nerve compression, though cerebrospinal fluid (CSF) leak is a known complication of this procedure. Bone cement cranioplasty may reduce rates of CSF leak. Objective To compare rates of CSF leak before and after implementation of bone cement cranioplasty for the reconstruction of cranial defects after MVD. Methods Retrospective chart review was performed of patients who underwent MVD through retrosigmoid craniectomy for cranial nerve compression at a single institution from 1998 to 2017. Study variables included patient demographics, medical history, type of closure, and postoperative complications such as CSF leak, meningitis, lumbar drain placement, and ventriculoperitoneal shunt insertion. Cement and noncement closure groups were compared, and predictors of CSF leak were assessed using a multivariate logistic regression model. Results A total of 547 patients treated by 10 neurosurgeons were followed up for more than 20 years, of whom 288 (52.7%) received cement cranioplasty and 259 (47.3%) did not. Baseline comorbidities were not significantly different between groups. CSF leak rate was significantly lower in the cement group than in the noncement group (4.5 vs. 14.3%; p < 0.001). This was associated with significantly fewer patients developing postoperative meningitis (0.7 vs. 5.2%; p = 0.003). Multiple logistic regression model demonstrated noncement closure as the only independent predictor of CSF leak (odds ratio: 3.55; 95% CI: 1.78–7.06; p < 0.001). Conclusion CSF leak is a well-known complication after MVD. Bone cement cranioplasty significantly reduces the incidence of postoperative CSF leak and other complications. Modifiable risk factors such as body mass index were not associated with the development of CSF leak.

Late seroma and infection in patients with cranioplasty implants after lateral suboccipital craniectomy

“…The wound complication rate of cranioplasty after retrosigmoid craniectomy ranged from 1.2-11.4%, depending on the cranioplasty materials used in one study [4]. However, no consistently significant difference in the infection rate was found according to the cranioplasty materials used in other studies [5,6]. We have previously reported the surgical outcomes of our institute, which involved less than 1% of wound dehiscence or infection rates after MVD, with complications only very rarely occurring several years after surgery [7,8].…”

Factors Predicting Cerebrospinal Fluid Leaks in Microvascular Decompressions: A Case Series of 1011 Patients

“…Otherwise, none of the bony cements that were used to reconstruct the craniectomies (including Porex, HydroSet, and DirectInject) were associated with CSF leak. [36][37][38] Previous reports in the literature have indicated surgeon experience to be strongly associated with the presence of CSF leaks. 39 We found that although surgeon experience less than 6 years was associated with CSF leaks on χ 2 analysis, this was not statistically significant on univariate or multivariate analysis.…”

“…Otherwise, none of the bony cements that were used to reconstruct the craniectomies (including Porex, HydroSet, and DirectInject) were associated with CSF leak. 36-38…”

Autologous bone fragments for skull reconstruction after microvascular decompression

“…Because an incomplete skull is associated with postoperative complications such as cerebrospinal fluid leakage, postoperative skull reconstruction is required even for small bone window craniotomy [7]. Materials used to repair cranial defects after MVD usually include autologous bone flaps and artificial biomaterials [8][9][10]. Surgeons favor autologous bone flaps because of their excellent histocompatibility [11,12].…”