Dura Closure Tactics to Prevent CSF Leakage in Microvascular Decompression Surgery

Area of Science:

• Neurosurgery
• Surgical Techniques
• Biomaterials

Background:

• Cerebrospinal fluid (CSF) leakage is a significant complication following microvascular decompression (MVD) surgery.
• Secure dural closure is essential to prevent CSF leakage and associated infections.
• A novel triple-layer closing technique was developed to address these challenges.

Purpose of the Study:

• To introduce and evaluate a novel three-step dural suturing method, the "triple-layer closing technique," for MVD procedures.
• To assess the efficacy of this technique in preventing CSF leakage and surgical site infections.

Main Methods:

• A retrospective analysis of 475 patients undergoing MVD between September 2020 and March 2023.
• All patients received dural closure using the triple-layer closing technique: Duragen®, TachoSil®, and polymethyl methacrylate (PMMC) bone cement.
• Postoperative complications, specifically CSF leakage and infections, were meticulously recorded and analyzed.

Main Results:

• A low incidence of CSF leakage was observed in 1.1% of patients (5 out of 475).
• All cases of CSF leakage presented as CSF rhinorrhea with mastoid air cell effusion and were successfully managed conservatively with lumbar drainage.
• No reoperations were required, and no other postoperative infections or complications were reported.

Conclusions:

• The triple-layer closing technique, incorporating Duragen®, TachoSil®, and PMMC bone cement, demonstrates high efficacy and reliability for dural closure in MVD.
• This innovative technique significantly reduces the risk of postoperative CSF leakage and surgical site infections.
• The triple-layer closing technique enhances overall postoperative outcomes in patients undergoing microvascular decompression.