Fat graft-assisted internal auditory canal closure after retrosigmoid transmeatal resection of acoustic neuroma: Technique for prevention of cerebrospinal fluid leakage.
The retrosigmoid transmeatal approach remains an important strategy in the surgical management of acoustic neuromas. Gross total resection of acoustic neuromas requires removal of tumor within the cerebellopontine angle as well as tumor involving the internal auditory canal (IAC). Drilling into the petrous bone of the IAC can expose petrous air cells, which can potentially result in a fistulous tract to the nasopharynx manifesting as cerebrospinal fluid (CSF) rhinorrhea. We describe our method of IAC closure using autologous fat graft and assessed the rates of postoperative CSF leakage. We performed a retrospective study of 24 consecutive patients who underwent retrosigmoid transmeatal resection of acoustic neuroma who underwent our method of fat graft-assisted IAC closure. We assessed rates of postoperative CSF leak (incisional leak, rhinorrhea, or otorrhea), pseudomeningocele formation, and occurrence of meningitis. Twenty-four patients (10 males, 14 females) with a mean age of 47 years (range 18-84) underwent fat graft-assisted IAC closure. No lumbar drains were used postoperatively. There were no instances of postoperative CSF leak (incisional leak, rhinorrhea, or otorrhea), pseudomeningocele formation, or occurrence of meningitis. There were no graft site complications. Our results demonstrate that autologous fat grafts provide a safe and effective method of IAC defect closure to prevent postoperative CSF leakage after acoustic tumor removal via a retrosigmoid transmeatal approach. The surgical technique and operative nuances are described.
Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
Tareq
T
Azad
Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
Zachary S
ZS
Mendelson
Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
Anni
A
Wong
Department of Otolaryngology - Head & Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
Robert W
RW
Jyung
Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA; Department of Otolaryngology - Head & Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA. Electronic address: james.liu.md@rutgers.edu.
James K
JK
Liu
D000273:Adipose Tissue / Q000637:transplantation*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002530:Cerebellopontine Angle / Q000601:surgery; D065634:Cerebrospinal Fluid Leak / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013701:Temporal Bone / Q000601:surgery; D014182:Transplantation, Autologous / Q000379:methods; D055815:Young Adult
Acoustic neuroma; Cerebrospinal fluid leak; Fat graft; Internal auditory canal; Retrosigmoid transmeatal approach; Skull base surgery