Management of Complications in Neurotology

Liu, James K.; Saedi, Targol; Delashaw, Johnny B.; McMenomey, Sean O.

doi:10.1016/j.otc.2007.03.008

Cited by 9 publications

(11 citation statements)

References 59 publications

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“…Care is taken to avoid compression of the sigmoid sinus, as this can sometimes result in venous outflow obstruction and possible venous hypertension. 15 The fat graft is then bolstered by a titanium mesh plate embedded in porous polyethylene (Medpor Titan implant, Stryker). The plate is secured to the edges of the bony mastoid defect with titanium screws.…”

Section: Operative Techniquementioning

confidence: 99%

“…5,27,30 Postoperative CSF leak rates for all acoustic neuroma surgery have been reported to range between 0% and 30% in the literature, but the mean leak rate remains approximately 10%. 1,[8][9][10]15,17,26,27 The postoperative CSF leak rates after translabyrinthine removal of acoustic neuromas range from 0% to 13% as reported in the most recent literature. 3,6,7,11,18,19,29 Reconstruction of presigmoid dural defects after resection of acoustic neuromas via the translabyrinthine approach is paramount to prevent postoperative CSF leakage.…”

mentioning

confidence: 99%

“…When the fat is overpacked and under pressure, symptomatic compression of the brainstem, cerebellum, and facial nerve can occur. 15 Other complications of autologous fat grafting include fat necrosis, subarachnoid fat embolism, lipoid meningitis, wound discharge, and local fistula formation. [23][24][25]28 Various other dural reconstruction techniques have been described, including covering the defect with a free temporalis muscle graft or a pedicled temporal fascial flap.…”

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confidence: 99%

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Fascial sling technique for dural reconstruction after translabyrinthine resection of acoustic neuroma: technical note

Liu¹,

Patel

Podolski

et al. 2012

FOC

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Reconstruction of presigmoid dural defects after resection of acoustic neuromas via the translabyrinthine approach is paramount to prevent postoperative CSF leakage. However, primary dural reapproximation and achieving a watertight closure of the dural defect in this anatomical region are quite difficult. Standard closure techniques after the translabyrinthine approach often involve packing an abdominal fat graft that plugs the dural defect and mastoidectomy cavity. This technique, however, may pose the risk of direct compression of the fat graft on the facial nerve and brainstem. Nonetheless, even with the evolution in dural repair techniques, postoperative CSF leaks can still occur and provide a route for infection and meningitis. In this report, the authors describe a novel dural “sling” reconstruction technique using autologous fascia lata to repair presigmoid dural defects created after translabyrinthine resection of acoustic neuromas. The fascia lata is sewn to the edges of the presigmoid dural defect to create a sling to suspend the fat graft within the mastoidectomy defect. A titanium mesh plate embedded in porous polyethylene is secured over the mastoidectomy defect to apply pressure to the fat graft. In the authors' experience, this has been a successful technique for dural reconstruction after translabyrinthine removal of acoustic neuromas to prevent postoperative CSF leakage. There were no cases of CSF leakage in the first 8 patients treated using this technique. The operative details and preliminary results of this technique are presented.

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Section: Operative Techniquementioning

confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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Fascial sling technique for dural reconstruction after translabyrinthine resection of acoustic neuroma: technical note

Liu¹,

Patel

Podolski

et al. 2012

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“…Post-operative cerebrospinal fluid (CFS) leakage can be a challenging and potentially hazardous problem following many complex cranial procedures. [1][2][3] This is especially true for surgical approaches to the skull base because a watertight dural reconstruction is not always feasible and CSF pulsation waves are greatest in this location. 1,3 CSF fistulas into the soft tissues at the base of the skull can cause pseudomeningoceles, which often become very painful and debilitating.…”

mentioning

confidence: 99%

“…[1][2][3] This is especially true for surgical approaches to the skull base because a watertight dural reconstruction is not always feasible and CSF pulsation waves are greatest in this location. 1,3 CSF fistulas into the soft tissues at the base of the skull can cause pseudomeningoceles, which often become very painful and debilitating. 1,2 In addition, drainage of spinal fluid from the skin increases the risk for surgical-site infections and meningitis.…”

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confidence: 99%

Reconstruction After Posterior Cranial Fossa Surgery—Case Report of Application of a Synthetic Tissue Sealant to Augment Dural Closure

Coppa¹,

Delashaw²

2010

US Neurology

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Cerebrospinal fluid (CSF) leakage following cranial surgery is a well-described and potentially devastating complication, particularly in posteriorcranial fossa surgery. If untreated, a persistent CSF leak can evolve into wound breakdown, a surgical-site infection, and meningitis. Themorbidity of a complication following a cranial operation is harmful to the patient. Additionally, complications are a source of elevated medicalcosts. Numerous reconstruction strategies have been developed to thwart the ill effects of CSF leaks on patient outcomes and healthcarefinances. This case report illustrates the method employed at our institution to repair posterior fossa defects following surgery in thecerebellopontine angle.

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