Staribacher Daniel, Kuzmin Dzmitry, Camal Ruggieri Iván N, Britz Gavin, Feigl Guenther C
Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany.
Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX, USA.
Neurosurg Rev. 2025 Aug 23;48(1):617. doi: 10.1007/s10143-025-03756-y.
Cerebrospinal fluid (CSF) leakage is a common postoperative complication after suboccipital craniotomies and can develop into a potentially life-threatening situation. Advances in dural replacement materials have revolutionized the treatment of CSF leaks and provide innovative alternatives to traditional repair methods. Synthetic and biological dural replacement materials, as well as fibrin sealants and tissue engineering approaches, offer improved durabilit, biocompatibility, and regenerative properties. However, to avoid complications associated with biomaterials and to minimize the use of dural substitutes whenever possible, careful surgical technique is essential for dural closure. Therefore, the aim of this study was to analyze the utility of a modified surgical technique for the retrosigmoid keyhole approach in reducing postoperative CSF leaks. A total of 168 consecutive patients were included in this retrospective study. All of them underwent surgery between 2015 and 2024 at our clinic for lesions in the cerebellopontine angle. A retrosigmoid keyhole approach was used in all cases. Two patients (1.2%) of the 168 developed a postoperative CSF leak: 1 (0.6%) incisional and 1 (0.6%) non-incisional. None of them developed CSF leak-related meningitis. The small retrosigmoid approach combined with the sandwich dural closure technique proved effective in reducing postoperative CSF leakage. While biomaterials contribute to improved dural sealing, careful surgical handling of posterior fossa structures remains essential for optimal outcomes. CLINICAL TRIAL NUMBER: Not applicable.
脑脊液漏是枕下开颅术后常见的并发症，可能发展为危及生命的情况。硬脑膜替代材料的进展彻底改变了脑脊液漏的治疗方法，并为传统修复方法提供了创新的替代方案。合成和生物硬脑膜替代材料，以及纤维蛋白密封剂和组织工程方法，具有更好的耐用性、生物相容性和再生特性。然而，为避免与生物材料相关的并发症，并尽可能减少硬脑膜替代物的使用，仔细的手术技术对于硬脑膜闭合至关重要。因此，本研究的目的是分析改良手术技术在乙状窦后锁孔入路中减少术后脑脊液漏的效用。本回顾性研究共纳入168例连续患者。他们均于2015年至2024年在我们诊所接受手术，治疗桥小脑角病变。所有病例均采用乙状窦后锁孔入路。168例患者中有2例（1.2%）发生术后脑脊液漏：1例（0.6%）为切口漏，1例（0.6%）为非切口漏。他们均未发生与脑脊液漏相关的脑膜炎。乙状窦后小入路联合三明治式硬脑膜闭合技术被证明在减少术后脑脊液漏方面有效。虽然生物材料有助于改善硬脑膜密封，但对后颅窝结构进行仔细的手术操作对于获得最佳结果仍然至关重要。临床试验编号：不适用。
