A Systematic Review of Closure Techniques in Lateral Skull Base Tumor Surgery

Introduction  Tumors of the lateral skull base often require collaboration between neurosurgeons and neurotologists for the surgical approach. The three main transosseous surgical approaches are retrosigmoid (RS), translabyrinthine (TL), and middle fossa (MF). The literature reflects a relative paucity regarding the various closure techniques for these approaches and the postoperative complications. We have performed a systematic review comparing closure techniques from each approach. Methods  A systematic review was performed using Ovid MEDLINE (1990-2016) on closure technique and postoperative complications for patients undergoing lateral skull base surgery via the TL, RS, or MF approach. Studies were included if they contained at least 10 patients, described their closure technique, and provided data on postoperative complications. Results  A total of 1,403 studies were reviewed. Of these, 53 studies met inclusion criteria yielding a total of 10,466 subjects in this analysis. The average rate of cerebrospinal fluid leak was 5.3% in the TL approach, 9% in the RS approach, and 6.2% in the MF approach. There was no significant effect of various closure techniques on postoperative wound complications in the MF approach. Multiple factors were identified which affected postoperative wound complication in the RS and TL approaches. Conclusion  There are a plethora of closure techniques for lateral skull base surgery. Several techniques were identified in this review that may affect the postoperative wound complication rates in lateral skull base surgery.