Prevention of Cerebrospinal Fluid Leak After Translabyrinthine Resection of Vestibular Schwannoma

Objective: Evaluate the rate of cerebrospinal fluid (CSF) leak after translabyrinthine craniotomy for the removal of vestibular schwannoma and describe details of closure technique. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: All individuals undergoing translabyrinthine craniotomy for removal of vestibular schwannoma from January 2000 to October 2008. Intervention: Translabyrinthine craniotomy for removal of vestibular schwannoma with abdominal fat graft harvest and layered closure. Main Outcome Measures: Presence of cerebrospinal fluid leak and need for additional surgeries or medical interventions. Results: Sixty-one patients underwent translabyrinthine craniotomy for the removal of vestibular schwannoma during a 9-year period. None of the patients had a CSF leak in the immediate postoperative period or during the mean follow-up period of 31.3 months. Conclusion: Successful wound closure and CSF leak prevention after translabyrinthine craniotomy for the removal of vestibular schwannomas do not require the creation of a facial recess, manipulation of the ossicles, direct Eustachian tube plugging, or the use of alloplastic space-occupying materials. The closure technique used in the current study has proven effective over time with no evidence of CSF leak among patients seen in follow-up.