Cisterna magna arachnoid membrane suturing decreases incidence of pseudomeningocele formation and incisional CSF leakage

Abstract

Suturing of the arachnoid membrane of the cisterna magna and its further sealing with fibrin adhesive sealant TachoComb® create an additional barrier for preventing cerebrospinal fluid collection in the extradural space. This technique significantly reduces the risk of postoperative pseudomeningocele formation and/or an incisional cerebrospinal fluid leak in patients with midline suboccipital craniotomy.

Suturing of the Arachnoid Membrane for Reconstruction of the Cisterna Magna: Technical Considerations

“…After completing all sutures without stretching the arachnoid membrane, the free end of the thread was pulled once along the suture to close the incised edges of arachnoid. 3 However, according to our clinical experiences, we believe that 6-0 or 7-0 sutures might injure the arachnoid membrane. Also, pulling the thread only at the end of suturing might cause arachnoid stretching and microtears.…”

“…The authors reported that arachnoid suturing significantly decreased the rate of CSF leakage into the subdural space. In addition, Pitskhelauri et al 3 investigated pseudomeningocele and incisional CSF leakage rates after cisterna magna surgery with arachnoid membrane suturing followed by sealing with fibrin adhesive material. The study enrolled 70 patients, 32 of whom were in the control group.…”

“…1 Postoperative CSF fistula can be complicated by meningitis, encephalitis, low-pressure headaches, chronic subdural hematomas and effusions, pseudomeningocele, arachnoiditis, dural-cutaneous fistula, pain, and pneumocephalus. 2,3 The development of complications may depend on the location and size of craniotomy, as well as patient-related factors such as age and systemic disease. These complications often lead to prolonged hospitalization, reoperation, and increased mortality and morbidity rates.…”

“…First, tight and reliable closure of the dura mater and fascia should be achieved. 3 Also, compressive bandaging, direct aspiration of subcutaneous CSF or diversion of ventricular CSF, 4 skin sutures, various tissue adhesives, 1,5 dural grafts, 6 and surgical closure of the fistula are some of the interventions that can prevent and treat CSF leakage outside the closed dural incision. 7 In this technical note, we report a case series in which continuous running suturing of the arachnoid membrane was included in cisterna magna reconstruction to prevent postoperative CSF-related complications.…”

Fourth Ventricle Tumors: A Review of Series Treated With Microsurgical Technique

“…The incidence of CSF leakage in the analyzed series varied from 0 to 27% ( 2 , 6 , 22 – 24 , 26 , 47 ), and the incidence of postoperative meningitis was noted in 0.47% - 20% of the cases ( 2 , 6 , 22 , 26 ).…”