Simple Reconstruction Method of Dural Defects for Minimal Anterior and Posterior Combined Transpetrosal Approach

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.

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.

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.

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.