Download PDF
J Neurol Surg B Skull Base 2021; 82(05): 556-561
DOI: 10.1055/s-0040-1715607
Original Article

Bone Cement Cranioplasty Reduces Cerebrospinal Fluid Leak Rate after Microvascular Decompression: A Single-Institutional Experience

Daniel I. Wolfson
1   Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, United States
,
Jordan A. Magarik
2   Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Saniya S. Godil
2   Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Hamid M. Shah
2   Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Joseph S. Neimat
3   Department of Neurological Surgery, University of Louisville Hospital, Louisville, Kentucky, United States
,
Peter E. Konrad
2   Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Dario J. Englot
2   Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Background Microvascular decompression (MVD) is a common surgical treatment for cranial nerve compression, though cerebrospinal fluid (CSF) leak is a known complication of this procedure. Bone cement cranioplasty may reduce rates of CSF leak.

Objective To compare rates of CSF leak before and after implementation of bone cement cranioplasty for the reconstruction of cranial defects after MVD.

Methods Retrospective chart review was performed of patients who underwent MVD through retrosigmoid craniectomy for cranial nerve compression at a single institution from 1998 to 2017. Study variables included patient demographics, medical history, type of closure, and postoperative complications such as CSF leak, meningitis, lumbar drain placement, and ventriculoperitoneal shunt insertion. Cement and noncement closure groups were compared, and predictors of CSF leak were assessed using a multivariate logistic regression model.

Results A total of 547 patients treated by 10 neurosurgeons were followed up for more than 20 years, of whom 288 (52.7%) received cement cranioplasty and 259 (47.3%) did not. Baseline comorbidities were not significantly different between groups. CSF leak rate was significantly lower in the cement group than in the noncement group (4.5 vs. 14.3%; p < 0.001). This was associated with significantly fewer patients developing postoperative meningitis (0.7 vs. 5.2%; p = 0.003). Multiple logistic regression model demonstrated noncement closure as the only independent predictor of CSF leak (odds ratio: 3.55; 95% CI: 1.78–7.06; p < 0.001).

Conclusion CSF leak is a well-known complication after MVD. Bone cement cranioplasty significantly reduces the incidence of postoperative CSF leak and other complications. Modifiable risk factors such as body mass index were not associated with the development of CSF leak.

Keywords

bone cement - cranioplasty - CSF leak - methyl methacrylate - microvascular decompression


Publication History

Received: 06 February 2020

Accepted: 22 May 2020

Article published online:
20 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Martínez-Anda JJ, Barges-Coll J, Ponce-Gomez JA, Perez-Pena N, Revuelta-Gutierrez R. Surgical management of trigeminal neuralgia in elderly patients using a small retrosigmoidal approach: analysis of efficacy and safety. J Neurol Surg A Cent Eur Neurosurg 2015; 76 (01) 39-45
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Barker II FG, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD. Microvascular decompression for hemifacial spasm. J Neurosurg 1995; 82 (02) 201-210
    CrossrefPubMedGoogle Scholar
  • 3 Barker II FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996; 334 (17) 1077-1083
    CrossrefPubMedGoogle Scholar
  • 4 Broggi G, Ferroli P, Franzini A, Servello D, Dones I. Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2000; 68 (01) 59-64
    CrossrefPubMedGoogle Scholar
  • 5 Holste K, Chan AY, Rolston JD, Englot DJ. Pain outcomes following microvascular decompression for drug-resistant trigeminal neuralgia: a systematic review and meta-analysis. Neurosurgery 2020; 86 (02) 182-190
    CrossrefPubMedGoogle Scholar
  • 6 Dubey A, Sung W-S, Shaya M. et al. Complications of posterior cranial fossa surgery--an institutional experience of 500 patients. Surg Neurol 2009; 72 (04) 369-375
    CrossrefPubMedGoogle Scholar
  • 7 Huh R, Han IB, Moon JY, Chang JW, Chung SS. Microvascular decompression for hemifacial spasm: analyses of operative complications in 1582 consecutive patients. Surg Neurol 2008; 69 (02) 153-157 , discussion 157
    CrossrefPubMedGoogle Scholar
  • 8 Fry DE. Surgical site infections and the surgical care improvement project (SCIP): evolution of national quality measures. Surg Infect (Larchmt) 2008; 9 (06) 579-584
    CrossrefPubMedGoogle Scholar
  • 9 Zhao H, Zhang X, Tang YD. et al. Operative complications of microvascular decompression for hemifacial spasm: experience of 1548 cases. World Neurosurg 2017; 107: 559-564
    CrossrefPubMedGoogle Scholar
  • 10 Silverman DA, Hughes GB, Kinney SE, Lee JH. Technical modifications of suboccipital craniectomy for prevention of postoperative headache. Skull Base 2004; 14 (02) 77-84
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Lee MH, Jee TK, Lee JA, Park K. Postoperative complications of microvascular decompression for hemifacial spasm: lessons from experience of 2040 cases. Neurosurg Rev 2016; 39 (01) 151-158 , discussion 158
    CrossrefPubMedGoogle Scholar
  • 12 Foster KA, Shin SS, Prabhu B, Fredrickson A, Sekula Jr RF. Calcium phosphate cement cranioplasty decreases the rate of cerebrospinal fluid leak and wound infection compared with titanium mesh cranioplasty: retrospective study of 672 Patients. World Neurosurg 2016; 95: 414-418
    CrossrefPubMedGoogle Scholar
  • 13 Eseonu CI, Goodwin CR, Zhou X. et al. Reduced CSF leak in complete calvarial reconstructions of microvascular decompression craniectomies using calcium phosphate cement. J Neurosurg 2015; 123 (06) 1476-1479
    CrossrefPubMedGoogle Scholar
  • 14 Wang DD, Raygor KP, Cage TA. et al. Prospective comparison of long-term pain relief rates after first-time microvascular decompression and stereotactic radiosurgery for trigeminal neuralgia. J Neurosurg 2018; 128 (01) 68-77
    CrossrefPubMedGoogle Scholar
  • 15 Ray DK, Bahgat D, McCartney S, Burchiel KJ. Surgical outcome and improvement in quality of life after microvascular decompression for hemifacial spasms: a case series assessment using a validated disease-specific scale. Stereotact Funct Neurosurg 2010; 88 (06) 383-389
    CrossrefPubMedGoogle Scholar
  • 16 Frederickson AM, Sekula Jr RF. The utility of calcium phosphate cement in cranioplasty following retromastoid craniectomy for cranial neuralgias. Br J Neurosurg 2013; 27 (06) 808-811
    CrossrefPubMedGoogle Scholar
  • 17 Stoker MA, Forbes JA, Hanif R. et al. Decreased rate of CSF leakage associated with complete reconstruction of suboccipital cranial defects. J Neurol Surg B Skull Base 2012; 73 (04) 281-286
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 van de Vijfeijken SECM, Münker TJAG, Spijker R. et al; CranioSafe Group. Autologous bone is inferior to alloplastic cranioplasties: safety of autograft and allograft materials for cranioplasties, a systematic review. World Neurosurg 2018; 117: 443-452.e8
    CrossrefPubMedGoogle Scholar
  • 19 U.S. Food and Drug Administration. List of Medical Devices, by Product Code, that FDA classifies as Implantable, Life-Saving, and Life-Sustaining Devices for purposes of Section 614 of FDASIA amending Section 519(f) of the FDC Act November 2012. https://www.fda.gov/media/85192/download . Accessed March 13, 2019
    Google Scholar
  • 20 Jagannath PM, Venkataramana NK, Bansal A, Ravichandra M. Outcome of microvascular decompression for trigeminal neuralgia using autologous muscle graft: a five-year prospective study. Asian J Neurosurg 2012; 7 (03) 125-130
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Afifi AM, Gordon CR, Pryor LS, Sweeney W, Papay FA, Zins JE. Calcium phosphate cements in skull reconstruction: a meta-analysis. Plast Reconstr Surg 2010; 126 (04) 1300-1309
    CrossrefPubMedGoogle Scholar
  • 22 Ducic Y. Titanium mesh and hydroxyapatite cement cranioplasty: a report of 20 cases. J Oral Maxillofac Surg 2002; 60 (03) 272-276
    CrossrefPubMedGoogle Scholar
  • 23 Li N, Zhao WG, Pu CH, Shen JK. Clinical application of artificial dura mater to avoid cerebrospinal fluid leaks after microvascular decompression surgery. Minim Invasive Neurosurg 2005; 48 (06) 369-372
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Aldahak N, Dupre D, Ragaee M, Froelich S, Wilberger J, Aziz KM. Hydroxyapatite bone cement application for the reconstruction of retrosigmoid craniectomy in the treatment of cranial nerves disorders. Surg Neurol Int 2017; 8 (01) 115
    CrossrefPubMedGoogle Scholar
  • 25 Ou C, Chen Y, Mo J. et al. Cranioplasty using polymethylmethacrylate cement following retrosigmoid craniectomy decreases the rate of cerebrospinal fluid leak and pseudomeningocele. J Craniofac Surg 2019; 30 (02) 566-570
    CrossrefPubMedGoogle Scholar
  • 26 Aydin S, Kucukyuruk B, Abuzayed B, Aydin S, Sanus GZ. Cranioplasty: review of materials and techniques. J Neurosci Rural Pract 2011; 2 (02) 162-167
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. ; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg 2014; 12 (12) 1495-1499
    CrossrefPubMedGoogle Scholar
  • 28 Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL. Gamma Knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute. Int J Radiat Oncol Biol Phys 2000; 47 (04) 1013-1019
    CrossrefPubMedGoogle Scholar
  • 29 Forbes J, Cooper C, Jermakowicz W, Neimat J, Konrad P. Microvascular decompression: salient surgical principles and technical nuances. J Vis Exp 2011; 45 (53) e2590
    PubMedGoogle Scholar
  • 30 Daudia A, Biswas D, Jones NS. Risk of meningitis with cerebrospinal fluid rhinorrhea. Ann Otol Rhinol Laryngol 2007; 116 (12) 902-905
    CrossrefPubMedGoogle Scholar
  • 31 Grotenhuis JA. Costs of postoperative cerebrospinal fluid leakage: 1-year, retrospective analysis of 412 consecutive nontrauma cases. Surg Neurol 2005; 64 (06) 490-493 , discussion 493–494
    CrossrefPubMedGoogle Scholar
  • 32 Dahle L, von Essen C, Kourtopoulos H, Ridderheim PA, Vavruch L. Microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien) 1989; 99 (3-4): 109-112
    CrossrefPubMedGoogle Scholar
  • 33 Luryi AL, Bulsara KR, Michaelides EM. Hydroxyapatite bone cement for suboccipital retrosigmoid cranioplasty: a single institution case series. Am J Otolaryngol 2017; 38 (04) 390-393
    CrossrefPubMedGoogle Scholar
  • 34 Ferroli P, Acerbi F, Tomei M, Tringali G, Franzini A, Broggi G. Advanced age as a contraindication to microvascular decompression for drug-resistant trigeminal neuralgia: evidence of prejudice?. Neurol Sci 2010; 31 (01) 23-28
    CrossrefPubMedGoogle Scholar
  • 35 Phan K, Rao PJ, Dexter M. Microvascular decompression for elderly patients with trigeminal neuralgia. J Clin Neurosci 2016; 29: 7-14
    CrossrefPubMedGoogle Scholar
  • 36 Arnone GD, Esfahani DR, Papastefan S. et al. Diabetes and morbid obesity are associated with higher reoperation rates following microvascular decompression surgery: an ACS-NSQIP analysis. Surg Neurol Int 2017; 8: 268
    CrossrefPubMedGoogle Scholar
  • 37 Copeland WR, Mallory GW, Neff BA, Driscoll CLW, Link MJ. Are there modifiable risk factors to prevent a cerebrospinal fluid leak following vestibular schwannoma surgery?. J Neurosurg 2015; 122 (02) 312-316
    CrossrefPubMedGoogle Scholar
  • 38 Kinaci A, Algra A, Heuts S, O'Donnell D, van der Zwan A, van Doormaal T. Effectiveness of dural sealants in prevention of cerebrospinal fluid leakage after craniotomy: a systematic review. World Neurosurg 2018; 118: 368-376.e1
    CrossrefPubMedGoogle Scholar
  • 39 Kabuto M, Kubota T, Kobayashi H, Handa Y, Tuchida A, Takeuchi H. MR imaging of cerebrospinal fluid rhinorrhea following the suboccipital approach to the cerebellopontine angle and the internal auditory canal: report of the two cases. Surg Neurol 1996; 45 (04) 336-340
    CrossrefPubMedGoogle Scholar