title: Sandwich Wound Closure Reduces the Risk of Cerebrospinal Fluid Leaks in Posterior Fossa Surgery.
abstract: Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.
authors.affiliation: Department of Neurosurgery, Sana Kliniken , Duisburg, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Heymanns
authors.affiliation: Department of Neurosurgery, Sana Kliniken , Duisburg, Germany.
authors.forename: Abidemi W
authors.initials: AW
authors.lastname: Oseni
authors.affiliation: Department of Neurosurgery, Sana Kliniken , Duisburg, Germany.
authors.forename: Ameer
authors.initials: A
authors.lastname: Alyeldien
authors.affiliation: Department of Neurosurgery, University Hospital , Essen, Germany.
authors.forename: Homajoun
authors.initials: H
authors.lastname: Maslehaty
authors.affiliation: Department of Neurosurgery, Sana Kliniken , Duisburg, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Parvin
authors.affiliation: Department of Neurosurgery, Sana Kliniken , Duisburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Scholz
authors.affiliation: Department of Neurosurgery, Heinrich Heine University , Duesseldorf, Germany.
authors.forename: Athanasios K
authors.initials: AK
authors.lastname: Petridis
keywords: Posterior fossa; cerebrospinal fluid leak; dural closure