Objective Despite advances in skull-base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a common complication following retrosigmoid (RS) vestibular schwannoma (VS) surgery. We aimed to review and classify the available strategies used to prevent CSF leaks following RS VS surgery.

Methods A systematic review, including studies of adults undergoing RS VS surgery since 2000, was conducted. Repair protocols were synthesized into a narrative summary, and a taxonomic classification of techniques and materials was produced. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were described.

Results All 42 studies were case series, of which 34 were retrospective, and eight were prospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A repair taxonomy was produced considering seven distinct stages to CSF leak prevention, including intraoperative approaches to the dura, internal auditory canal (IAC), air cells, RS bony defect, extracranial soft tissue, postoperative dressings, and CSF diversion. Notably, there was significant heterogeneity among institutions, particularly in the dural and IAC stages. The median postoperative incidence of CSF leaks was 6.3% (IQR: 1.3–8.44%).

Conclusions The intraoperative strategies used to prevent CSF leaks during RS VS surgery vary between and within institutions. As a result of this heterogeneity and inconsistent reporting of CSF leak predictive factors, a meaningful comparative analysis of repair protocols was not feasible. Instead, we propose the development of a prospective multicenter observational evaluation designed to accurately capture a comprehensive dataset of potential CSF risk factors, including all stages of the operative repair protocol.

目的 尽管颅底重建技术取得了进步，脑脊液（CSF）漏仍然是乙状结肠后（RS）前庭神经鞘瘤（VS）手术后的常见并发症。我们的目的是回顾和分类用于预防 RS VS 手术后脑脊液漏的可用策略。

方法 我们 进行了一项系统回顾，其中包括自 2000 年以来接受 RS VS 手术的成年人的研究。修复方案被综合成叙述性摘要，并产生了技术和材料的分类。此外，还描述了不同修复方案的优点、缺点和相关的脑脊液漏率。

结果 42 项研究均为病例系列研究，其中 34 项为回顾性研究，8 项为前瞻性研究。修复策略包括自体移植物、异种移植物和合成材料的异质组合。考虑到预防脑脊液漏的七个不同阶段，制定了修复分类法，包括术中硬脑膜、内听道 (IAC)、气囊、RS 骨缺损、颅外软组织、术后敷料和脑脊液改道。值得注意的是，各机构之间存在显着的异质性，特别是在硬脑膜和 IAC 阶段。术后脑脊液漏的中位发生率为 6.3%（IQR：1.3-8.44%）。

结论 RS VS 手术期间用于预防脑脊液漏的术中策略因机构之间和机构内部而异。由于脑脊液漏预测因素的这种异质性和不一致的报告，对修复方案进行有意义的比较分析是不可行的。相反，我们建议开发前瞻性多中心观察评估，旨在准确捕获潜在脑脊液风险因素的综合数据集，包括手术修复方案的所有阶段。