Fat implant is superior to muscle implant in vestibular schwannoma surgery for the prevention of cerebrospinal fluid fistulae.
OBJECTIVE
Meticulous sealing of opened air cells in the petrous bone is necessary for the prevention of cerebrospinal fluid (CSF) fistulae after vestibular schwannoma surgery. We performed a retrospective analysis to determine whether muscle or fat tissue is superior for this purpose.


METHODS
Between January 2001 and December 2006, 420 patients underwent retrosigmoidal microsurgical removal by a standardized procedure. The opened air cells at the inner auditory canal and the mastoid bone were sealed with muscle in 283 patients and with fat tissue in 137 patients. Analysis was performed regarding the incidence of postoperative CSF fistulae and correlation with the patient's sex and tumor grade.


RESULTS
The rate of postoperative CSF leak after application of fat tissue was lower (2.2%) than after use of muscle (5.7%). Women had less postoperative CSF leakage (3.4%) than men (5.6%). There was an inverse correlation with tumor grade. Patients with smaller tumors seemed to have a higher rate of CSF leakage than those with large tumors without hydrocephalus. Only large tumors with severe dislocation of the brainstem causing hydrocephalus showed a higher incidence of CSF leaks.


CONCLUSIONS
Fat implantation is superior to muscle implantation for the prevention of CSF leakage after vestibular schwannoma surgery and should, therefore, be used for the sealing of opened air cells in cranial base surgery.
Lüdemann
Wolf O
WO
Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany. Luedemann@ini-hannover.de
Stieglitz
Lennart H
LH
Gerganov
Venelin
V
Samii
Amir
A
Samii
Madjid
M
D001705:Bioprosthesis; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D004424:Ear Canal / Q000473:pathology / Q000601:surgery; D005260:Female; D005402:Fistula / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000637:transplantation*; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012737:Sex Factors; D050151:Subcutaneous Fat / Q000637:transplantation*