Sandwich wound closure reduces the risk of cerebrospinal fluid leaks in posterior fossa surgery

  • Verena Heymanns Department of Neurosurgery, Sana Kliniken, Duisburg, Germany.
  • Abidemi W. Oseni Department of Neurosurgery, Sana Kliniken, Duisburg, Germany.
  • Ameer Alyeldien Department of Neurosurgery, Sana Kliniken, Duisburg, Germany.
  • Homajoun Maslehaty Department of Neurosurgery, University Hospital, Essen, Germany.
  • Richard Parvin Department of Neurosurgery, Sana Kliniken, Duisburg, Germany.
  • Martin Scholz Department of Neurosurgery, Sana Kliniken, Duisburg, Germany.
  • Athanasios K. Petridis | opticdisc@aol.com Department of Neurosurgery, Heinrich Heine University, Duesseldorf, Germany.

Abstract

Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.

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Published
2016-07-04
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Section
Brief Reports
Keywords:
Posterior fossa, dural closure, cerebrospinal fluid leak.
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How to Cite
Heymanns, V., Oseni, A. W., Alyeldien, A., Maslehaty, H., Parvin, R., Scholz, M., & Petridis, A. K. (2016). Sandwich wound closure reduces the risk of cerebrospinal fluid leaks in posterior fossa surgery. Clinics and Practice, 6(2). https://doi.org/10.4081/cp.2016.824

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