Prevention of Postoperative Cerebrospinal Fluid Leaks After Translabyrinthine Tumor Resection With Resorbable Mesh Cranioplasty.

Hunter, Jacob B; Sweeney, Alex D; Carlson, Matthew L; Wanna, George B; Rivas, Alejandro; Weaver, Kyle D; Chambless, Lola B; Thompson, Reid S; Haynes, David S; Bennett, Marc L

OBJECTIVES To evaluate the effectiveness of resorbable mesh cranioplasty at reducing postoperative cerebrospinal fluid (CSF) leak and pseudomeningocele formation after translabyrinthine tumor resection. STUDY DESIGN Case series with chart review. SETTING Tertiary academic referral center. PATIENTS Fifty-three consecutive cases using a resorbable mesh cranioplasty after translabyrinthine tumor resection were reviewed. INTERVENTION Temporal bone defects were repaired with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws. MAIN OUTCOME MEASURES Primary outcome measures included the incidence of postoperative CSF wound leak or rhinorrhea, pseudomeningocele formation, and surgical site infection. RESULTS Fifty-three cases (average age, 54.0 yr; range, 19.3-75.1 yr) were analyzed. The average body mass index was 30.8 kg/m2 (range, 17.9-48.3 kg/m2), and the average tumor size was 18.8 mm (range, 8-38 mm). One patient (1.9%) experienced CSF rhinorrhea on postoperative Day 16, which resolved after transmastoid middle ear and eustachian tube packing. One patient (1.9%) experienced a surgical site infection requiring surgical debridement and mesh removal 4 months after surgery. Compared with 1,441 prior translabyrinthine surgeries analyzed from our institution using a traditional fat graft closure without mesh, the rate of postoperative CSF leak was significantly less using the resorbable mesh cranioplasty technique (p = 0.0483). CONCLUSION Resorbable mesh cranioplasty is a safe and effective method to reduce postoperative CSF leak and pseudomeningocele formation after translabyrinthine craniotomy for tumor excision.