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Management of postoperative CSF rhinorrhea after retrosigmoid craniotomy: how I do it

  • How I Do it - Tumor - Schwannoma
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Abstract

Background

Cerebrospinal fluid (CSF) rhinorrhea as a complication of retrosigmoid craniotomy does not occur often today. This complication is primarily associated with the petrous bone drilling during surgery.

Method

The management of this complication is shown by the example of the patient with a trigeminal schwannoma located in posterior cranial fossa operated through resrisigmoid craniotomy. Three steps of management and surgical stages of petrous bone plasty are shown.

Conclusion

CSF rhinorrhea after retrosigmoid craniotomy is a preventable complication: petrous bone pneumatization should be evaluated preoperatively. If the air cells are open, primary plasty of the defect should be performed.

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Abbreviations

CT:

Computer tomography

DTI:

Diffusion-weighted imaging

CSF:

Cerebrospinal fluid

MRI:

Magnetic resonance imaging

References

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Author information

Authors and Affiliations

  1. Privolzhskiy Research Medical University, Nizhny Novgorod, Russian Federation

    Anton Ermolaev, Konstantin Yashin & Igor Medyanik

  2. Moscow Regional Research and Clinical Institute, Moscow, Russian Federation

    Anton Ermolaev & Revaz Dzhindzhikhadze

Authors
  1. Anton Ermolaev
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  2. Konstantin Yashin
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  3. Revaz Dzhindzhikhadze
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  4. Igor Medyanik
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Corresponding author

Correspondence to Anton Ermolaev.

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Key points

Patient should be informed about the symptoms of CSF rhinorrhea.

Petrous bone pneumatization should be evaluated preoperatively: CT scan is recommended.

If the air cells are open, primary plasty of the defect should be performed.

Prediction of the location of the leak is important: does it come from the mastoid opening or from the perimeatal air cells. CT cisternography can be performed.

Dura plasty is primary for extradural CSF leak prevention.

CSF rhinorrhea can be resolved by lumbar drainage in most cases.

Petrous bone plasty without resection of its air cells can be used only if there is a wide anatomical access to the defect.

Petrosal “sandwich” plasty including autological tissues combined with synthetic material can be an effective method for intradural defect closure.

We use bovine albumin + glutaraldehyde adhesive composition only extradurally. Dynamic cytological monitoring of the cerebrospinal fluid should be performed.

This article is part of the Topical Collection on Tumor - Schwannoma

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Ermolaev, A., Yashin, K., Dzhindzhikhadze, R. et al. Management of postoperative CSF rhinorrhea after retrosigmoid craniotomy: how I do it. Acta Neurochir 164, 2559–2562 (2022). https://doi.org/10.1007/s00701-022-05186-x

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  • DOI: https://doi.org/10.1007/s00701-022-05186-x

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