ArticleNeurosurgery practice2024
A Reliable Closure Technique for Retromastoid Craniotomy to Avoid Cerebrospinal Fluid Leaks and Meningitis.
Article in Neurosurgery practice, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Cerebrospinal fluid leakage in patients after retrosigmoid approach for tumor resection: systematic review of techniques to manage dural closure and cranial reconstruction.Neurosurgical review · 2025Pooled it
- Modified Dandy Stair-Step Incision for Retrosigmoid Craniotomies to Reduce Postoperative Complications in Skull Base Surgery.Journal of neurological surgery. Part B, Skull base · 2026Article
- A Stitch in Time Saves Nine: Retrosigmoid Craniotomy with Layered Suboccipital Muscle Dissection to Prevent Cerebrospinal Fluid Leak and Infection.Journal of neurological surgery. Part B, Skull base · 2026Article
- Review
- Severe trauma care: advances and future directions in diagnostic and therapeutic techniques and information technology support.Medical review (2021) · 2026Article
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Authors and funding
5 authors.
Funding
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Abstract
BACKGROUND AND
objectivesPostoperative cerebrospinal fluid (CSF) leaks and meningitis are well-known risks of retromastoid craniotomy. Use of abdominal fat grafts, collagen allografts, and rigid or semirigid buttresses have demonstrated efficacy in preventing CSF leaks and meningitis in endoscopic endonasal surgery. This study aims to determine the utility of a similar multilayered reconstruction technique for retromastoid craniotomy.
methodsWe retrospectively reviewed 212 consecutive patients who underwent retromastoid craniotomy for tumor removal or microvascular decompression from 2007 to 2022. Scalp incisions were linear or slightly curved, muscle and facia opening was performed sharply avoiding monopolar cautery; craniotomies had a maximum dimension of 3 cm. A primary water-tight dural closure was rarely achieved favoring collagen sponge overlay often augmented with autologous fat. Clinical factors including pathology, mastoid air cell entry, and reconstruction material were analyzed. Outcomes including postoperative CSF leakage and meningitis were assessed.
resultsOf 212 patients (mean age 56 ± 16 years; 60% female; 10% with prior surgery), 148 (70%) had tumor resection and 64 (30%) had microvascular decompression. Mastoid air cells were breached in 67%. Collagen sponge dural overlay was used in 201/212 (95%). A fat graft was placed in 116 (55%) cases: 69% with air cell entry, 27% without air cell entry; 158 (75%) patients had their bone flap replaced, 46 (21%) had titanium mesh cranioplasty, 8 (4%) had no bone flap or titanium mesh. There were no CSF leaks or meningitis. One patient had a lumbar drain placement preoperatively, none postoperatively. Median length of stay was 2 days.
conclusionRetromastoid craniotomy multilayered reconstruction with liberal use of collagen sponge and abdominal fat grafts seems to reliably avoid postoperative CSF leaks and meningitis including in the setting of nonwatertight dural closure and mastoid cell entry. Use of shorter incisions, avoidance of monopolar cautery, and a relatively small craniotomy may contribute to the absence of CSF leaks in this series.
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