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Techniques of Dural Closure for Zero CSF Leak

  • Luciano MastronardiEmail author
  • Guglielmo Cacciotti
  • Alberto Campione
  • Ali Zomorodi
  • Raffaelino Roperto
  • Takanori Fukushima
Chapter

Abstract

CSF fistulas into the soft tissues of the skull base can cause wound breakdown and/or pseudomeningocele, which often becomes very painful and debilitating. In addition, drainage of spinal fluid from the skin increases the risk for surgical site infections and meningitis. Diverse techniques for posterior cranial fossa dural reconstruction and closure have been reported: application of synthetic dural patches, incorporation of autologous tissues, and augmentation with “muscle plugs.” Even if a variety of dural substitutes is currently available, many articles in the literature suggest that autologous materials are preferable compared to nonautologous substitutes. Our group reported the use of autologous pericranium harvested during the opening step of retrosigmoid approach, inserted and stitched as an underlay hourglass-shaped plug for dural closure. We did not observe any surgical site infections, meningitis, CSF leaks, or new neurological symptoms using properly this dural closure technique.

Keywords

Vestibular schwannoma/fistula Vestibular schwannoma/cranioplasty Vestibular schwannoma/dural closure 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Luciano Mastronardi
    • 1
    Email author
  • Guglielmo Cacciotti
    • 1
  • Alberto Campione
    • 1
  • Ali Zomorodi
    • 2
  • Raffaelino Roperto
    • 1
  • Takanori Fukushima
    • 2
  1. 1.Department of NeurosurgerySan Filippo Neri Hospital—ASLRoma1RomeItaly
  2. 2.Division of Neurosurgery, Duke University Medical CenterCarolina Neuroscience InstituteRaleighUSA

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