Cerebrospinal Fluid Leak Following Translabyrinthine Vestibular Schwannoma Surgery-Is Mesh Cranioplasty Necessary for Prevention?

Objective: Evaluate the incidence of cerebrospinal fluid leak following vestibular schwannoma surgery for mesh cranioplasty closure versus periosteal closure in the translabyrinthine approach. Determine nonsurgical variables associated with higher rates of cerebrospinal fluid leak following vestibular schwannoma surgery.

Study Design: Retrospective chart review.

Setting: Tertiary academic referral center.

Patients: One hundred thirty-two patients with adequate documentation who underwent sporadic vestibular schwannoma resection via a translabyrinthine approach between 2000 and 2019.

Intervention: Translabyrinthine excision of vestibular schwannoma with mesh cranioplasty closure or watertight periosteal closure.

Main Outcome Measures: Primary outcome measures included the incidence of postoperative cerebrospinal fluid leak, total length of hospital stay (including the initial hospital stay as well as hospital days during any readmission within 30 days), and total operative time.

Results: Our overall cerebrospinal fluid leak rate was 9.1% with a leak rate of 12.8% in our translabyrinthine titanium mesh closure group and 0% in our translabyrinthine periosteal closure. There was no statistically significant effect of age, body mass index, or size of tumor on the incidence of cerebrospinal fluid leak. There was also no statistically significantly difference between the two groups on length of operative time or number of days spent in the intensive care unit.

Conclusion: Mesh cranioplasty is not a prerequisite for achieving a low cerebrospinal fluid leak rate following translabyrinthine approach for vestibular schwannoma resection. In our series, a significantly lower cerebrospinal fluid leak rate was demonstrated with the periosteal closure.