Approach Design and Closure Techniques to Minimize Cerebrospinal Fluid Leak after Cerebellopontine Angle Tumor Surgery

OBJECTIVE: The purpose of the study was to identify specific aspects of surgical approach design and closure technique aimed at reducing the incidence of cerebrospinal fluid leak after cerebellopontine angle tumor surgery. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: All patients undergoing cerebellopontine angle tumor surgery at the study institution from January 1996 through September 2004. MAIN OUTCOME MEASURE: The presence or absence of cerebrospinal fluid leak after various surgical approaches for a wide variety of cerebellopontine angle tumors. RESULTS: Three hundred forty three patients underwent surgery for cerebellopontine angle tumors at the study institution during the study period. Tumor types in descending order of frequency were as follows: acoustic neuroma, 244; cerebellopontine angle meningiomas, 33; petroclival meningiomas, 32; foramen magnum meningiomas, 10; epidermoid tumors, 9; facial nerve tumors, 6; hemangiopericytomas, 3; schwannomas of glossopharyngeal/spinal accessory nerves, 3; and unusual internal auditory canal tumors, 3. Surgical approaches used for tumor resection included translabyrinthine, retrosigmoid, combined transpetrosal, far lateral/transcondylar, middle cranial fossa, and extended middle cranial fossa. During the nearly 8-year study period, four postoperative cerebrospinal fluid leaks were encountered, resulting in a leak rate of 1.2%. Two of these patients required surgical repair of their leaks; the other two stopped spontaneously. The authors describe specific aspects of approach design and closure that appear to have a positive impact on postoperative cerebrospinal fluid leak rates. CONCLUSION: Attention to specific aspects of surgical approach design and wound closure results in a reduced incidence of cerebrospinal fluid leak after surgery for cerebellopontine angle tumors.