title: Underlay hourglass-shaped autologous pericranium duraplasty in "key-hole" retrosigmoid approach surgery: Technical report.
abstract: BACKGROUND
  Cerebrospinal fluid (CSF) leakages represent a major complication of skull base surgery. Watertight dural suture is challenging, and different ways to reinforce it have been proposed. Since 6 months, we use locally harvested autologous pericranium graft for dural repair in retrosigmoid approach.
  
  
  METHODS
  Retrospectively, we analyzed 27 patients operated on with key-hole retrosigmoid approach from May 2014. In all, autologous pericranium was harvested and inserted as an underlay "hourglass-shaped" plug under the dura plane and stitched to dura. Surgical patch and sealant were used for augmentation. Complications considered were new neurological symptoms, surgical site infections, meningitis, CSF-leaks, and pseudomeningocele.
  
  
  RESULTS
  Indications included tumor (16 cases), microvascular decompression (10 cases), and hemorrhagic cerebellar arteriovenous malformation (1 case). Surgical site infections, meningitis, and CSF leaks have never been observed. One neurofibromatosis type 2 patient operated on for large acoustic neuroma developed an asymptomatic pseudomeningocele, disappeared on 3-month magnetic resonance imaging follow-up.
  
  
  CONCLUSIONS
  In our series, autologous pericranium inserted and stitched as an underlay hourglass-shaped plug, augmented with surgical patch pieces and dural sealant seemed to be safe and effective for dural repair in "key-hole" retrosigmoid approach. With this technique, we obtained low complication rate, similar to the best current results of available literature.
authors.affiliation: Department of Neurosurgery, San Filippo Neri Hospital, Roma, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Mastronardi
authors.affiliation: Department of Neurosurgery, San Filippo Neri Hospital, Roma, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Cacciotti
authors.affiliation: Department of Neurosurgery, San Filippo Neri Hospital, Roma, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Caputi
authors.affiliation: Department of Neurosurgery, San Filippo Neri Hospital, Roma, Italy.
authors.forename: Raffaelino
authors.initials: R
authors.lastname: Roperto
authors.affiliation: Department of Neurosurgery, San Filippo Neri Hospital, Roma, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Tonelli
authors.affiliation: Department of Neurosurgery, San Filippo Neri Hospital, Roma, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Carpineta
authors.affiliation: Department of Neurosurgery, Carolina Neuroscience Institute, Raleigh, North Carolina, USA.
authors.forename: Takanori
authors.initials: T
authors.lastname: Fukushima
keywords: Autologous pericranium patch; cerebrospinal fluid-related complications; duraplasty; retrosigmoid approach