title: Microplate-bridge technique for watertight dural closures in the combined petrosal approach.
abstract: BACKGROUND
  Although the combined petrosal approach has significant advantages for medium to large petroclival lesions, it carries the risk of a few major complications. The cerebrospinal fluid leak rate with this approach has been reported to be as high as 15%.
  
  
  OBJECTIVE
  To describe an innovative technique of watertight dural closure with a long microplate-bridge technique for the combined petrosal approach.
  
  
  METHODS
  We describe our method of watertight dural closures with the microplate-bridge technique for combined petrosal approaches using cadaveric heads and clinical cases. We review our postoperative outcomes in respect to cerebrospinal fluid leaks.
  
  
  RESULTS
  The technique involves a fascial graft to the presigmoid-subtemporal defect, fixated with a long microtitanium plate over the cranial base side. The fascial graft is augmented by covering it with an abdominal fat graft and a vascularized pericranial flap. This technique was performed in 23 patients after surgical resection of petroclival meningiomas with only 1 postoperative cerebrospinal fluid leak (4.4%).
  
  
  CONCLUSIONS
  We recommend this safe and simple closure technique during skull base surgery.
authors: Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA. kusumi@med.kitasato-u.ac.jp
authors: Mari
authors: M
authors: Kusumi
authors: Takanori
authors: T
authors: Fukushima
authors: Hamidreza
authors: H
authors: Aliabadi
authors: Ankit I
authors: AI
authors: Mehta
authors: Shusaku
authors: S
authors: Noro
authors: Charles L
authors: CL
authors: Rosen
authors: Kiyotaka
authors: K
authors: Fujii
mesh_terms: D000328:Adult; D002102:Cadaver; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010579:Petrous Bone / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*