Auricchio Anna Maria, Martinelli Renata, Offi Martina, Nichelatti Michele, Valeri Federico, Rapisarda Alessandro, Di Domenico Michele, Montano Nicola, Olivi Alessandro, Della Pepa Giuseppe Maria
1Department of Neurosurgery, Fondazione Policlinico A. Gemelli IRCCS, Rome; and.
2Complex Structure of Clinical Research and Innovation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Neurosurg Focus. 2025 Feb 1;58(2):E8. doi: 10.3171/2024.11.FOCUS24681.
This study evaluated the effectiveness of various dural closure and bone reconstruction techniques in preventing CSF leakage following retrosigmoid craniotomy for cerebellopontine angle (CPA) tumors. The goal was to identify whether newer combinations of reconstructive materials offer any advantage in reducing CSF leaks and improving surgical outcomes.
The authors conducted a retrospective review of 225 patients who underwent a retrosigmoid craniotomy for CPA neoplasms between January 2018 and August 2024. Patient demographics, intraoperative reports, and postoperative complications were analyzed. Various reconstructive methods, including the use of TachoSil, HydroSet, autologous or heterologous dural patches, and bone flap repositioning, were compared. CSF-related complications such as CSF leakage, infections, and postoperative hydrocephalus were systematically evaluated.
CSF leakage occurred in 31% of cases (n = 69), while CSF infections and postoperative hydrocephalus were noted in 6% and 7% of patients, respectively. HydroSet combined with bone flap repositioning significantly reduced CSF leakage (p = 0.008), as did the combination of HydroSet and heterologous dural patches (p = 0.007). TachoSil did not show a significant reduction in CSF leakage. Craniectomy with titanium mesh or heterologous cranioplasty was not associated with any CSF leaks. No other single or combined techniques showed significant associations with CSF leakage.
HydroSet in combination with bone reconstruction and heterologous patches demonstrated superior outcomes in reducing CSF leaks. TachoSil did not significantly affect leakage rates, with less definite results. Refining surgical techniques and selecting appropriate materials for dural and bone reconstruction may help reduce complications and improve patient outcomes in CPA tumor surgeries using the retrosigmoid approach.
本研究评估了在乙状窦后入路切除桥小脑角（CPA）肿瘤后，各种硬脑膜闭合和骨重建技术在预防脑脊液漏方面的有效性。目标是确定重建材料的新组合在减少脑脊液漏和改善手术结果方面是否具有任何优势。
作者对2018年1月至2024年8月期间接受乙状窦后入路切除CPA肿瘤的225例患者进行了回顾性研究。分析了患者的人口统计学数据、术中报告和术后并发症。比较了各种重建方法，包括使用速即纱、HydroSet、自体或异体硬脑膜补片以及骨瓣重新定位。系统评估了与脑脊液相关的并发症，如脑脊液漏、感染和术后脑积水。
31%的病例（n = 69）发生了脑脊液漏，而分别有6%和7%的患者出现了脑脊液感染和术后脑积水。HydroSet与骨瓣重新定位联合使用可显著减少脑脊液漏（p = 0.008），HydroSet与异体硬脑膜补片联合使用也有同样效果（p = 0.007）。速即纱在减少脑脊液漏方面未显示出显著效果。使用钛网或异体颅骨成形术进行颅骨切除术与任何脑脊液漏均无关联。没有其他单一或联合技术与脑脊液漏有显著关联。
HydroSet与骨重建和异体补片联合使用在减少脑脊液漏方面显示出更好的效果。速即纱对漏液率没有显著影响，结果不太明确。改进手术技术并选择合适的材料进行硬脑膜和骨重建，可能有助于减少使用乙状窦后入路的CPA肿瘤手术中的并发症并改善患者预后。
