Comparison of Cranioplasty Techniques Following Translabyrinthine Surgery: Implications for Postoperative Pain and Opioid Usage

Sioshansi, Pedrom C.; Xiong, Mulin; Tu, Nathan; Bojrab, Dennis I.; Schutt, Christopher A.; Babu, Seilesh

doi:10.1097/mao.0000000000003295

Cited by 2 publications

(16 citation statements)

References 33 publications

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“…19 Twenty-one out of 25 studies reported that the The ET could be occluded (or packed), or not treated at all. [15][16][17][18][19][20]23,[25][26][27][28]31,32,34,35,36,38,41,49,[55][56][57][58] Two studies analysed the impact of ET closure on CSF rates, both concluding ET packing did not influence CSF leak rates. 19,23 Considering the materials used to pack the eustachian tube, the many studies reported the use of muscle, typically harvested from the temporalis or from the sternocleidomastoid.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…19,23 Considering the materials used to pack the eustachian tube, the many studies reported the use of muscle, typically harvested from the temporalis or from the sternocleidomastoid. [15][16][17][18][19][20]23,[25][26][27]31,32,36,38,56,58 Muscle was combined with either fascia 19,20,23,26,58 , oxidised cellulose (Surgicel) 17,19,[25][26][27]36,38 or tissue glue. 16,17,56 Other alternatives to muscle grafts for ET packing were: polytetrafluoroethylene and carbon filaments (Proplast) 19 , high molecular weight polyethylene (Plastipore) 19 , surgicel 19,41 , dry periosteum 17,32,34,55,57 , or the incus.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…16,[18][19][20]23,24,25,26,28,[30][31][32][33][34][35][37][38][39][40][41]50,55,56,[58][59][60] Materials used for packing included autologous grafts (muscle 16,18,19,20,21,23,24,25,26,28,30,31,35,39,41,46,49,50,58 ,fat 40 , dry periosteum 32,33,36,42,48,55 ) and synthetic substitutes (e.g. HAC…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Concerning autologous reconstruction materials, although bone dust would have the biocompatibility and ability to promote bone growth, it increases operative time, donor site complications, and is limited by quantity. 64,65 As such, the most commonly used autologous graft used to fill the craniectomy dead space is abdominal fat, which was reported in a majority of studies [15][16][17][18]20,[22][23][24][25][26][27][28][29][31][32][33][34][35][36][37][38][39]41,42,46,[48][49][50][55][56][57][58][59][60][61]66 . Fat graft advantages include long-term durability, revascularisation, plentiful abundance, excellent compatibility, and the lack of artefact on post-operative surveillance imaging.…”

Section: Translabyrinthine Bony Defectmentioning

confidence: 99%

“…The authors note limitations of bone flaps include the risk of resorption and donor site morbidity and specify that the technique is unsuitable for small contracted mastoid cavities or those with anatomical variants such as a laterally placed sigmoid sinus. 29 An alternative or adjunct to fat packing of the TL cavity is reconstruction with hydroxyapatite bone cement(HAC) 20,21,24,36,38,47,48,51 . Proponents of hydroxyapatite praise its tensile strength, enabled through osteoblastic stimulation, as well as improved cosmesis and reduced tissue traction 24 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Skull Base Repair following Resection of Vestibular Schwannoma: A Systematic Review (Part 2: The Translabyrinthine Approach)

Starup-Hansen,

Williams,

Valetopoulou

et al. 2023

J Neurol Surg B Skull Base

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Objectives: Despite advances in skull base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a relatively common complication after translabyrinthine (TL) vestibular schwannoma (VS) surgery. We conducted a systematic review to synthesise the repair techniques and materials used in TL VS surgery to prevent CSF leaks. Design: A systematic review of studies published since 2000 reporting techniques to prevent CSF leaks during adult TL VS surgery was conducted. A narrative synthesis of primary repair protocols was produced, and a taxonomy was established. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were extracted. Results: All 43 studies were case series, and 39 were retrospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A taxonomy was produced, classifying repairs into seven distinct stages, including approaches to the dura, middle ear cleft, air cells, TL bony defect, extra-cranial soft tissue, post-operative dressings and CSF diversion. The median post-operative incidence of CSF leaks was 6% (IQR 0-10%). Conclusions: This systematic review reveals substantial inter-institutional heterogeneity in intraoperative strategies to prevent CSF leaks following TL VS surgery. However, comparing these techniques is challenging due to the multiple predictive factors for CSF leaks and their inconsistent reporting. We propose a taxonomy of seven stages to classify operative techniques and materials aimed at preventing CSF leaks. We recommend that future evaluations should adopt a prospective approach encompassing data collection strategies that consider all operative stages described by our taxonomy.

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