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Unique Far-Lateral Closure Technique: Technical Note.

Jonathan Perry Scoville1, Marcus D Mazur1, William T Couldwell1

  • 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah.

Operative Neurosurgery (Hagerstown, Md.)
|June 26, 2019
PubMed
Summary

A novel far-lateral closure technique significantly reduces cerebrospinal fluid leaks after craniocervical junction surgery. This method, using dural closure and fat buttress, lowers leak rates from 20% to 2.9%.

Keywords:
Cerebrospinal fluid leakCraniocervical junctionFar-lateral approachSkull baseSurgical closure

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Area of Science:

  • Neurosurgery
  • Skull Base Surgery

Background:

  • The far-lateral approach is crucial for accessing the ventrolateral craniocervical junction for tumor and vascular lesion treatment.
  • A significant challenge is the high reported rate of cerebrospinal fluid (CSF) leaks (up to 20%) following this approach, leading to complications like meningitis and prolonged hospitalization.

Purpose of the Study:

  • To present a specific closure technique designed to mitigate CSF leaks associated with the far-lateral approach.
  • To illustrate the application of this technique through a case study.

Main Methods:

  • The described technique involves meticulous dural closure.
  • A fat graft is utilized as a buttress to obliterate dead space, thereby minimizing fluid collection and leakage.

Main Results:

  • The senior author has employed this technique successfully for over 14 years.
  • The observed rate of cerebrospinal fluid leak using this closure method is 2.9%, a substantial reduction from previously reported rates.

Conclusions:

  • This specialized closure technique for far-lateral craniotomies offers a viable solution for accessing the ventrolateral craniocervical junction.
  • Skull base surgeons can consider this method to achieve a watertight closure and reduce the incidence of CSF leaks.