Intraoperative management to prevent cerebrospinal fluid leakage after microvascular decompression: dural closure with a "plugging muscle" method.
Our objective is to present surgical techniques used for the prevention of cerebrospinal fluid leakage after microvascular decompression (MVD). From January 1996 to February 2006, microvascular decompression for hemifacial spasm or trigeminal neuralgia was performed in 678 consecutive patients. In order to achieve watertight dural closure, several pieces of muscle were interposed between the dura when the dura was sutured; the dura was stitched with the addition of muscle pieces to plug the dural defect. In cases where the mastoid air cell system was opened, bone wax was used to seal the opened surface of the cavity, and a muscle patch was applied for the secondary sealing. The cranioplasty was performed using polymethylmethacrylate (PMMA) bone cement. Only 2 (0.29%) of 678 patients, who underwent MVD followed by dural closure using several muscle pieces to plug the potential dural defect, suffered from CSF leaks. Both were treated with lumbar subarachnoid drainage; neither patient required a lumbar peritoneal shunt or a revision operation. A watertight dural closure with the addition of muscle pieces in a "plugging" fashion, along with sealing the opened surface of the mastoid cavity using bone wax and cranioplasty using bone cement, provides a simple and effective technique for the prevention of CSF leakage after MVD.
Park
Jae Sung
JS
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, South Korea.
Kong
Doo-Sik
DS
Lee
Jeong-A
JA
Park
Kwan
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000517:prevention & control*; D003389:Cranial Nerve Diseases / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects*; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery; D013536:Suture Techniques
D001843:Bone Cements; D019904:Polymethyl Methacrylate