Bone Sandwich Closure Technique for Posterior Fossa Craniectomy

Abstract

Background Surgery of posterior fossa including cerebellopontine (CP) angle involves either craniectomy or craniotomy. While there has been precedence of craniotomy in recent practice, the preferred access in resource-strapped centers still remains been craniectomy. Although the latter offers an excellent exposure, it is believed to carry increased risk of postoperative pseudomeningocoele and cerebrospinal fluid (CSF) leak compared with craniotomy. Methods We have suggested a technique by which after standard craniectomy for the posterior fossa surgeries the bony defect is covered by Gelfoam bone sandwich (GBS) technique. We studied this technique over a period of 25.6 years in 1,028 patients. Results and Conclusion We analyze the risk of pseudomeningocoele and CSF leak in our patients using GBS technique and reviewed literature to compare our outcomes with standard craniotomy and craniectomy procedures.

Risk Factors for Central Nervous System Infections After Craniotomy

“…In that case, it is easy to cause cerebrospinal fluid leakage in the incision, and pathogenic bacteria will enter the skull retrograde along the incision. 22 , 23 Couple with the possibility of liquefaction necrosis of fat, it affects wound healing and provides an opportunity for bacterial colonization.…”

“…The cerebrospinal fluid leakage connects the body’s brain tissue with the outside world, allowing the pathogenic bacteria to enter the intracranial space, leading to CNS infection. 23 Once intracranial infection occurs, it will increase intracranial pressure, further aggravating cerebrospinal fluid leakage. Cerebrospinal fluid leakage can stimulate an inflammatory response in surrounding tissue, leading to swelling and blood circulation changes.…”

Revision Surgery Technique in the Treatment of Refractory Subcutaneous Cerebrospinal Fluid Collection Combined with Intracranial Infection Following Posterior Fossa Surgery

“…Cerebrospinal fluid (CSF) leakage remains a serious complication that most commonly occurs following posterior fossa surgery and presents as subcutaneous CSF fluid collection (aka pseudomeningocele) [ 1 - 3 ]. Persistent subcutaneous CSF collection can cause wound dehiscence and leakage of CSF through the incision, which then leads to wound and/or intracranial infection [ 2 ]. Conservative treatments consist of head elevation, antibiotics, acetazolamide, and applying local pressure with compression bandage [ 4 ].…”