Acta Neurochirurgica

, Volume 160, Issue 5, pp 1079–1087 | Cite as

Cisterna magna arachnoid membrane suturing decreases incidence of pseudomeningocele formation and incisional CSF leakage

  • David Pitskhelauri
  • Elina Kudieva
  • Dmitrii Moshchev
  • Evgeny Ananev
  • Michail Shifrin
  • Gleb Danilov
  • Tatiana Melnikova-Pitskhelauri
  • Igor Kachkov
  • Andrey Bykanov
  • Alexander Sanikidze
Original Article - Neurosurgical Techniques



A pseudomeningocele and an incisional cerebrospinal fluid leak are considered frequent complications following neurosurgical operations. The rate of these complications especially increases following neurosurgical procedures on the posterior cranial fossae. According to some publications, the rate of pseudomeningoceles has been reported as high as 40%, whereas that of incisional cerebrospinal fluid leaks is up to 17%. For the purposes of reducing the risk of these complications after a midline suboccipital craniotomy, we propose suturing the arachnoid membrane of the cisterna magna. In this paper, we present a retrospective analysis of arachnoid membrane suturing.


Seventy patients underwent midline suboccipital craniotomy by the first author between 2012 and 2016 at Burdenko Neurosurgery Institute. In this group was included a consecutive group of patients with posterior fossae tumors where the approach was performed through the cisterna magna arachnoid membrane following midline suboccipital craniotomy and dural opening. The patients were divided into two groups. Group 1 included 38 patients to whom cisterna magna arachnoid membrane suturing was performed with monofilament nonabsorbable suture 7.0., and additionally, the suture was sealed with fibrin adhesive sealant TachoComb®. Group 2 included 32 patients without arachnoid membrane suturing. There was no other significant difference in terms of clinical signs and surgical procedures between these groups. In the postoperative period, the frequency of developing a pseudomeningocele and an incisional cerebrospinal fluid leak was assessed in these two groups. The results were evaluated on the basis of clinical, CT, and MRI data performed in the postoperative period.


In the patients who underwent arachnoid membrane suturing (group I), pseudomeningocele formation was observed in one (2.6%) and CSF leak in one (2.6%) of the 38 patients. In group II, in which patients had no arachnoid membrane suturing, we observed pseudomeningocele formation in 11 (34.4%) patients and a CSF leak in 7 (25.0%) out of 28 patients with known follow-up. Statistical analysis of the data indicates a significantly higher risk of postoperative pseudomeningocele formation and/or an incisional cerebrospinal fluid leak in a group of patients who did not undergo arachnoid membrane suturing (p < 0.05).


Suturing of the arachnoid membrane of the cisterna magna and its further sealing with fibrin adhesive sealant TachoComb® create an additional barrier for preventing cerebrospinal fluid collection in the extradural space. This technique significantly reduces the risk of postoperative pseudomeningocele formation and/or an incisional cerebrospinal fluid leak in patients with midline suboccipital craniotomy.


Arachnoid suturing CSF leak Pseudomeningocele Suboccipital 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee of Burdenko Neurosurgery Institute and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • David Pitskhelauri
    • 1
  • Elina Kudieva
    • 1
  • Dmitrii Moshchev
    • 2
  • Evgeny Ananev
    • 2
  • Michail Shifrin
    • 3
  • Gleb Danilov
    • 3
    • 5
  • Tatiana Melnikova-Pitskhelauri
    • 4
  • Igor Kachkov
    • 6
  • Andrey Bykanov
    • 1
  • Alexander Sanikidze
    • 1
  1. 1.Burdenko Neurosurgery Center, Department of Neuro-oncologyMoscowRussia
  2. 2.Burdenko Neurosurgery Center, Department of Anesthesiology and Intensive careMoscowRussia
  3. 3.Burdenko Neurosurgery Center, Department of Information TechnologyMoscowRussia
  4. 4.Burdenko Neurosurgery Center, Department of NeuroradiologyMoscowRussia
  5. 5.Burdenko Neurosurgery Center, Scientific SecretariatMoscowRussia
  6. 6.Moscow Regional Research and Clinical Institute, Department of NeurosurgeryMoscowRussia

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