Prevention of Cerebrospinal Fluid Leaks and Transtemporal Surgery of Acoustic Tumors

Abstract

In neurosurgical practice, postoperative cerebrospinal fluid (CSF) METHODSThe technique we have used for exposure and removal of space-occupying lesions located in the cerebellopontine angle is the modified transotic approach described by Fisch and Mattox. 10 To solve the problem of CSF leaks and subgaleal collections of CSF, a few changes have been instituted. The technique is as follows.1. Prior to making the head incision, the anterolateral aspect of the upper thigh is prepared and draped and an adequate amount of fat harvested. At the same time, a 6 x 8 cm piece of fascia lata is also harvested. Particular care is taken not to make a hole in this graft. The edges of the defect created in the fascia lata is approximated as closely as possible and the skin incision closed in two layers. A suction drain is left under the skin flap.2. While the fat is being harvested from the thigh, blood is drawn by venepuncture to prepare the autologous fibrin glue. Seventy-two milliliters of the patient's blood is mixed with 8 ml of sterile 10% sodium citrate solution. Equal volumes of this mixture is poured into eight sterile tubes and centrifuged at 3200 rpm for 10 minutes. The supernatant plasma from each tube is then poured into 199