Comparison of different wound closure techniques in translabyrinthine acoustic neuroma surgery.

In a series of 277 patients with translabyrinthine acoustic neuroma, three techniques of wound closure were used to prevent cerebrospinal fluid (CSF) leakage. In the first group, we used a piece of fascia to cover the dural defect and then placed several pieces of fat on the fascia. The incidence of CSF leak was 28.2%; 7.7% required reoperation. In the second group, in addition to the fasia-fat complex, we made a large musculoperiosteal flap to compress the fat. The incidence of CSF leak and revision were not reduced, however. In recent cases, we placed several pieces of fat directly into the operative cavity without fascia graft; then it was covered with a musculoperiosteal flap. With this technique, CSF leak was significantly reduced to 7.4%, and reoperation was rare (3.7%). The direct application of fat into the translabyrinthine operation cavity appears to be effective to prevent CSF leaks.