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Reconstruction after retrosigmoid approaches using autologous fat graft-assisted Medpor Titan cranioplasty: assessment of postoperative cerebrospinal fluid leaks and headaches in 60 cases

  • Clinical Article - Brain Tumors
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Abstract

Background

Postoperative cerebrospinal fluid (CSF) leaks and headaches remain potential complications after retrosigmoid approaches for lesions in the posterior fossa and cerebellopontine angle. The authors describe a simple repair technique with an autologous fat graft-assisted Medpor Titan cranioplasty and investigate the incidence of postoperative CSF leaks and headaches using this technique.

Methods

A retrospective chart review was conducted on all cases (n = 60) of retrosigmoid craniectomy from September 2009 to May 2014 in patients who underwent fat graft-assisted cranioplasty. After obtaining a watertight dural closure and sealing off any visible mastoid air cells with bone wax, an autologous fat graft was placed over the dural suture line and up against the waxed-off air cells. The fat graft filled the retrosigmoid cranial defect and was then bolstered with a Medpor Titan (titanium mesh embedded in porous polyethylene) cranioplasty. A postoperative mastoid pressure dressing was applied for 48 h, and prophylactic lumbar drainage was not used. Factors examined in this study included postoperative CSF leak (incisional, rhinorrhea, otorrhea), pseudomeningocele formation, incidence and severity of postoperative headache, length of hospital stay, and length of follow-up.

Results

No patients developed postoperative CSF leaks (0 %), pseudomeningoceles (0 %), or new-onset postoperative headaches (0 %) with the described repair technique. There were no cases of graft site morbidity such as hematoma or wound infection. Mean duration of postoperative hospital stay was 3.8 days (range 2–10 days). Mean postoperative follow-up was 12.4 months (range 2.0–41.1 months).

Conclusions

Our multilayer repair technique with a fat graft-assisted Medpor Titan cranioplasty appears effective in preventing postoperative CSF leaks and new-onset postoperative headaches after retrosigmoid approaches. Postoperative lumbar drainage may not be necessary.

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Authors and Affiliations

  1. Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA

    Phoebe Y. Ling, Zachary S. Mendelson, Rohit K. Reddy & James K. Liu

  2. Department of Otolaryngology—Head & Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA

    Robert W. Jyung & James K. Liu

  3. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, NJ, USA

    James K. Liu

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  1. Phoebe Y. Ling
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  2. Zachary S. Mendelson
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Correspondence to James K. Liu.

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Ling, P.Y., Mendelson, Z.S., Reddy, R.K. et al. Reconstruction after retrosigmoid approaches using autologous fat graft-assisted Medpor Titan cranioplasty: assessment of postoperative cerebrospinal fluid leaks and headaches in 60 cases. Acta Neurochir 156, 1879–1888 (2014). https://doi.org/10.1007/s00701-014-2190-x

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  • DOI: https://doi.org/10.1007/s00701-014-2190-x

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