Microplate-Bridge Technique for Watertight Dural Closures in the Combined Petrosal Approach

Abstract

BACKGROUND: Although the combined petrosal approach has significant advantages for medium to large petroclival lesions, it carries the risk of a few major complications. The cerebrospinal fluid leak rate with this approach has been reported to be as high as 15%. OBJECTIVE: To describe an innovative technique of watertight dural closure with a long microplate-bridge technique for the combined petrosal approach. METHODS: We describe our method of watertight dural closures with the microplate-bridge technique for combined petrosal approaches using cadaveric heads and clinical cases. We review our postoperative outcomes in respect to cerebrospinal fluid leaks. RESULTS: The technique involves a fascial graft to the presigmoid-subtemporal defect, fixated with a long microtitanium plate over the cranial base side. The fascial graft is augmented by covering it with an abdominal fat graft and a vascularized pericranial flap. This technique was performed in 23 patients after surgical resection of petroclival meningiomas with only 1 postoperative cerebrospinal fluid leak (4.4%). CONCLUSION: We recommend this safe and simple closure technique during skull base surgery.

Simplified Dural Reconstruction Procedure Using Biocompatible Polyglycolic Acid Felt with Autologous Abdominal Fat Grafts after a Transpetrosal Approach

“…Of note, none of these 10 cases needed postoperative CSF drainage; In addition, only 1 patient required revision surgery due to subcutaneous fluid collection, and none of the remaining 9 patients experienced any dural reconstruction-related complications, such as CSF leakage or postsurgical infection. In recent expert series, the CSF leakage rate after a transpetrosal approach was 5% to 15% 11,12 . In this context, we consider the CSF leakage rate of our PGA felt group (10%) to be acceptable.…”

“…To address this problem of incomplete closure, various dural substitutes have been used in skull base surgeries [5][6][7][8][9][10][11][12][13] . Autologous transplants, including temporal fascia, pericranium flap, and fascia lata, are the most popular materials among neurosurgeons because autografts minimize the likelihood of immunoreactivity and induction of an inflammatory response 6 .…”

A novel duraplasty technique following fenestration of a massive lumbar arachnoid cyst in a patient with scoliosis: technical case report

“…We adopted principles of dural reconstruction with multilayer closure, similar to those used in skull base reconstruction. 6,8 We reconstructed the posterior elements with titanium mesh fortified with an MMA layer. This reconstruction was critical to the successful outcome because it eliminated the dead space created by the laminectomy defects and provided a barrier to CSF egress.…”

Radiographic assessment of the presigmoid retrolabyrinthine approach

“…The presigmoid approach is also complicated by difficult dural closure, increased risk of spinal fluid leak, and increased risk of hearing loss. [ 13 26 29 ] With multiple reports that suggest the equivalence in achieving the surgical goals between presigmoid and retrosigmoid approaches in even the most complex petroclival pathology, the ideal approach for an individual lesion remains controversial particularly for those deemed accessible by both techniques. [ 6 16 17 20 25 27 ]…”