Clinical Article - Brain Tumors

Acta Neurochirurgica

, Volume 155, Issue 12, pp 2281-2286

First online:

Craniotomy vs. craniectomy for posterior fossa tumors: a prospective study to evaluate complications after surgery

  • Federico G. LegnaniAffiliated withDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
  • , Andrea SaladinoAffiliated withDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
  • , Cecilia CasaliAffiliated withDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
  • , Ignazio G. VetranoAffiliated withDepartment of Neurosurgery, Università degli Studi di Milano
  • , Marco VariscoAffiliated withDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
  • , Luca MatteiAffiliated withDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo BestaDepartment of Neurosurgery, Università degli Studi di Milano
  • , Francesco PradaAffiliated withDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
  • , Alessandro PerinAffiliated withDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
  • , Antonella MangravitiAffiliated withDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
    • , Carlo L. SoleroAffiliated withDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta
    • , Francesco DiMecoAffiliated withDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo BestaDepartment of Neurosurgery, Johns Hopkins University Email author 

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Abstract

Background

Posterior fossa surgery traditionally implies permanent bone removal. Although suboccipital craniectomy offers an excellent exposure, it could lead to complications. Thus, some authors proposed craniotomy as a valuable alternative to craniectomy. In the present study we compare post-operative complications after craniotomy or craniectomy for posterior fossa surgery.

Methods

We prospectively collected data for a consecutive series of patients who underwent either posterior fossa craniotomy or craniectomy for tumor resection. We divided patients into two groups based on the surgical procedure performed and safety, complication rates and length of hospitalization were analyzed. Craniotomies were performed with Control-Depth-Attachment® drill and chisel, while we did craniectomies with perforator and rongeurs.

Results

One-hundred-fifty-two patients were included in the study (craniotomy n = 100, craniectomy n = 52). We detected no dural damage after bone removal in both groups. The total complication rate related to the technique itself was 7 % for the craniotomy group and 32.6 % for the craniectomy group (<0.0001). Pseudomeningocele occurred in 4 % vs. 19.2 % (p = 0.0009), CSF leak in 2 % vs. 11.5 % (p = 0.006) and wound infection in 1 % vs. 1.9 % (p = 0.33), respectively. Post-operative hydrocephalus, a multi-factorial complication which could affect our results, was also calculated and occurred in 4 % of the craniotomy vs. 9.6 % of the craniectomy group (p = 0.08). The mean length of in-hospital stay was 9.3 days for the craniotomy group and 11.8 days for the craniectomy group (p = 0.10).

Conclusions

The present study suggests that fashioning a suboccipital craniotomy is as effective and safe as performing a craniectomy; both procedures showed similar results in preserving dural integrity, while post-operative complications were fewer when a suboccipital craniotomy was performed.

Keywords

Brain tumor Craniectomy Craniotomy CSF leak Posterior fossa Pseudomeningocele