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Article Abstract
Background: The minimal anterior posterior combined (MAPC) transpetrosal approach is a valuable technique for accessing petroclival lesions with supra-infratentorial extensions. However, dural reconstruction following this approach presents significant challenges owing to subtemporal and presigmoid dural and transtentorial incisions, dural shrinkage resulting from coagulation, and spatial constraints.
Methods: This study retrospectively examined 25 patients who underwent MAPC transpetrosal approach between 2022 and 2024. We employed a simplified method of dural reconstruction using a fat graft and a sternocleidomastoid muscle-periosteum-temporal fascia flap without suturing. An absorbable polyglycolic acid material was fixed along the flap using fibrin glue to reinforce the sealing of the dura (question number 4, reviewer #1). The evaluation was conducted with a focus on subcutaneous cerebrospinal fluid (S-CSF) collection based on postoperative magnetic resonance imaging findings, and the strategies employed to address this complication were assessed.
Results: Of the 25 cases examined, 16 showed no evidence of S-CSF accumulation (grade 0). Two patients were classified as grade 1, while 7 patients exhibited grade 2 S-CSF collection. None of the patients experienced cerebrospinal fluid (CSF) leakage through the surgical incision nor did they develop CSF rhinorrhea or otorrhea. All instances of S-CSF accumulation resolved spontaneously within 2-6 weeks, without requiring surgical intervention. Only 1 patient with a history of repeat surgery required CSF diversion via a lumbar drain postoperatively.
Conclusions: The simple dural reconstruction method using autologous fat graft and sternocleidomastoid temporal fascia flap demonstrated promising results in terms of preventing CSF-related complications following the MAPC transpetrosal approach.
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| http://dx.doi.org/10.1016/j.wneu.2025.123795 | DOI Listing |
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