Download PDF
CC BY 4.0 · J Neurol Surg B Skull Base
DOI: 10.1055/a-2222-0016
Original Article

Skull Base Repair following Resection of Vestibular Schwannoma: A Systematic Review (Part 2: The Translabyrinthine Approach)

Joachim Starup-Hansen 
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Simon C. Williams
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
3   Department of Neurosurgery, The Royal London Hospital, London United Kingdom
,
Alexandra Valetopoulou
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Danyal Z. Khan
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Hugo Layard Horsfall 
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Jigishaa Moudgil-Joshi
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Oliver Burton
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Hala Kanona
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
5   The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
,
Shakeel R. Saeed
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
5   The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
6   University College London Ear Institute, London, United Kingdom
,
William Muirhead
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Hani J. Marcus   *
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
,
Patrick Grover   *
1   Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London NHS Trust, London, United Kingdom
2   Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
› Author Affiliations Funding This study was funded by Wellcome/EPSRC Centre for Interventional and Surgical Sciences.
Wellcome (203145Z/16/Z), EPSRC (NS/A000050/1).
› Further Information
   Permissions and Reprints

Abstract

Objectives Despite advances in skull base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a relatively common complication after translabyrinthine (TL) vestibular schwannoma (VS) surgery. We conducted a systematic review to synthesize the repair techniques and materials used in TL VS surgery to prevent CSF leaks.

Design A systematic review of studies published since 2000 reporting techniques to prevent CSF leaks during adult TL VS surgery was conducted. A narrative synthesis of primary repair protocols was produced, and a taxonomy was established. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were extracted.

Results All 43 studies were case series, and 39 were retrospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A taxonomy was produced, classifying repairs into seven distinct stages, including approaches to the dura, middle ear cleft, air cells, TL bony defect, extra-cranial soft tissue, postoperative dressings, and CSF diversion. The median postoperative incidence of CSF leaks was 6% (interquartile range: 0–10%).

Conclusions This systematic review reveals substantial inter-institutional heterogeneity in intraoperative strategies to prevent CSF leaks following TL VS surgery. However, comparing these techniques is challenging due to the multiple predictive factors for CSF leaks and their inconsistent reporting. We propose a taxonomy of seven stages to classify operative techniques and materials aimed at preventing CSF leaks. We recommend that future evaluations should adopt a prospective approach encompassing data collection strategies that considers all operative stages described by our taxonomy.

Keywords

vestibular schwannoma - CSF leak - skull base repair - neurosurgery - ear nose and throat - translabyrinthine approach

* Equal senior authorship.


Supplementary Material



Publication History

Received: 05 September 2023

Accepted: 25 November 2023

Accepted Manuscript online:
04 December 2023

Article published online:
22 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Roberti F, Wind JJ, Perez R, Caputy AJ. The translabyrinthine approach in residency training. “Step by step” surgical anatomy from the dissection laboratory to the operative room. J Otol 2021; 16 (02) 99-108
    CrossrefPubMedGoogle Scholar
  • 2 Sughrue ME, Yang I, Aranda D. et al. Beyond audiofacial morbidity after vestibular schwannoma surgery. J Neurosurg 2011; 114 (02) 367-374
    CrossrefPubMedGoogle Scholar
  • 3 McRackan TR, Brackmann DE. Historical perspective on evolution in management of lateral skull base tumors. Otolaryngol Clin North Am 2015; 48 (03) 397-405
    CrossrefPubMedGoogle Scholar
  • 4 Ansari SF, Terry C, Cohen-Gadol AA. Surgery for vestibular schwannomas: a systematic review of complications by approach. Neurosurg Focus 2012; 33 (03) E14
    CrossrefPubMedGoogle Scholar
  • 5 Fang C, Zhu T, Zhang P, Xia L, Sun C. Risk factors of neurosurgical site infection after craniotomy: a systematic review and meta-analysis. Am J Infect Control 2017; 45 (11) e123-e134
    CrossrefPubMedGoogle Scholar
  • 6 Sathaporntheera P, Saetia K. Risk factors associated with CSF leakage and complications after retrosigmoid surgery. Interdiscip Neurosurg 2020; 22: 100865
    CrossrefPubMedGoogle Scholar
  • 7 Chern A, Hunter JB, Bennett ML. Cost analysis of cerebrospinal fluid leaks and cerebrospinal fluid leak prevention in patients undergoing cerebellopontine angle surgery. Otol Neurotol 2017; 38 (01) 147-151
    CrossrefPubMedGoogle Scholar
  • 8 Montano N, Signorelli F, Giordano M. et al. Factors associated with cerebrospinal fluid leak after a retrosigmoid approach for cerebellopontine angle surgery. Surg Neurol Int 2021; 12: 258
    CrossrefPubMedGoogle Scholar
  • 9 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
  • 10 Becker SS, Jackler RK, Pitts LH. Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches. Otol Neurotol 2003; 24 (01) 107-112
    CrossrefPubMedGoogle Scholar
  • 11 Stieglitz LH, Giordano M, Gerganov VM, Samii A, Samii M, Lüdemann WO. How obliteration of petrosal air cells by vestibular schwannoma influences the risk of postoperative CSF fistula. Clin Neurol Neurosurg 2011; 113 (09) 746-751
    CrossrefPubMedGoogle Scholar
  • 12 Crowson MG, Cunningham III CD, Moses H, Zomorodi AR, Kaylie DM. Preoperative lumbar drain use during acoustic neuroma surgery and effect on CSF Leak incidence. Ann Otol Rhinol Laryngol 2016; 125 (01) 63-68
    CrossrefPubMedGoogle Scholar
  • 13 Khan DZ, Ali AMS, Koh CH. et al. Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review. Pituitary 2021; 24 (05) 698-713
    CrossrefPubMedGoogle Scholar
  • 14 Dekkers OM, Vandenbroucke JP, Cevallos M, Renehan AG, Altman DG, Egger M. COSMOS-E: guidance on conducting systematic reviews and meta-analyses of observational studies of etiology. PLoS Med 2019; 16 (02) e1002742
    CrossrefPubMedGoogle Scholar
  • 15 Hillman TA, Shelton C. Resorbable plate cranioplasty after the translabyrinthine approach. Otol Neurotol 2011; 32 (07) 1171-1174
    CrossrefPubMedGoogle Scholar
  • 16 Sen A, Green KMJ, Khan MIJ, Saeed SR, Ramsden RT. Cerebrospinal fluid leak rate after the use of BioGlue in translabyrinthine vestibular schwannoma surgery: a prospective study. Otol Neurotol 2006; 27 (01) 102-105
    CrossrefPubMedGoogle Scholar
  • 17 Moderie C, Maniakas A, Moumdjian R, Alhabib SF, Saliba I. Eustachian tube obliteration and its effect on rhinoliquorrhea in translabyrinthine vestibular schwannoma excision. J Int Adv Otol 2017; 13 (02) 191-194
    CrossrefPubMedGoogle Scholar
  • 18 Kalamarides M, Grayeli AB, Bouccara D, Redondo A, Rey A, Sterkers O. Opening cerebrospinal fluid pressure guides the management of cerebrospinal fluid leakage after acoustic neuroma surgery. Otol Neurotol 2004; 25 (05) 769-772
    CrossrefPubMedGoogle Scholar
  • 19 Jacob A, Bortman JS, Robinson Jr LL, Yu L, Dodson EE, Welling DB. Does packing the eustachian tube impact cerebrospinal fluid rhinorrhea rates in translabyrinthine vestibular schwannoma resections?. Otol Neurotol 2007; 28 (07) 934-938
    CrossrefPubMedGoogle Scholar
  • 20 Sioshansi PC, Xiong M, Tu NC, Bojrab DI, Schutt CA, Babu SC. Comparison of cranioplasty techniques following translabyrinthine surgery: implications for postoperative pain and opioid usage. Otol Neurotol 2021; 42 (10) e1565-e1571
    CrossrefPubMedGoogle Scholar
  • 21 Arriaga MA, Chen DA. Hydroxyapatite cement cranioplasty in translabyrinthine acoustic neuroma surgery. Otolaryngol Head Neck Surg 2002; 126 (05) 512-517
    CrossrefPubMedGoogle Scholar
  • 22 Liu JK, Patel SK, Podolski AJ, Jyung RW. Fascial sling technique for dural reconstruction after translabyrinthine resection of acoustic neuroma: technical note. Neurosurg Focus 2012; 33 (03) E17
    CrossrefPubMedGoogle Scholar
  • 23 Plainfossé O, Puechmaille M, Saroul N. et al. Prevention of cerebrospinal fluid leak after vestibular schwannoma surgery: a case-series focus on mastoid air cells' partition. Eur Arch Otorhinolaryngol 2022; 279 (04) 1777-1785
    CrossrefPubMedGoogle Scholar
  • 24 Martinez-Perez R, Kunigelis KE, Ward RC. et al. Hydroxyapatite cement cranioplasty for reconstruction of translabyrinthine approach: aesthetic results, long-term satisfaction, quality of life, and complications. Acta Neurochir (Wien) 2022; 164 (03) 669-677
    CrossrefPubMedGoogle Scholar
  • 25 Totten DJ, Manzoor NF, Yancey KL, Yawn RJ, Haynes DS, Rivas A. Comparison of small intestinal submucosal graft and autologous tissue in prevention of CSF leak after posterior fossa craniotomy. J Neurol Surg B Skull Base 2021; 82 (06) 695-699
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Christopher L, Slattery W, Lekovic GP, Mehta GU, Miller M. Matched cohort analysis of the effect of the facial recess approach on cerebrospinal fluid leak after translabyrinthine surgery for schwannoma. Otol Neurotol 2021; 42 (09) 1394-1398
    CrossrefPubMedGoogle Scholar
  • 27 Selleck AM, Hodge SE, Brown KD. Cerebrospinal fluid leak following translabyrinthine vestibular schwannoma surgery - Is mesh cranioplasty necessary for prevention?. Otol Neurotol 2021; 42 (05) e593-e597
    CrossrefPubMedGoogle Scholar
  • 28 Netto AATDC, Colafêmina JF, Centeno RS. Dural defect repair in translabyrinthine acoustic neuroma surgery and its implications in cerebrospinal fluid leak occurrence. J Neurol Surg B Skull Base 2012; 73 (05) 327-330
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Yuen HW, Thompson AL, Symons SP, Pirouzmand F, Chen JM. Vascularized mastoid bone flap cranioplasty after translabyrinthine vestibular schwannoma surgery. Skull Base 2009; 19 (03) 193-201
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Luryi AL, Schutt CA, Michaelides E, Kveton JF. Hydroxyapatite cement cranioplasty for translabyrinthine surgery: a single institution experience. Laryngoscope 2020; 130 (01) 206-211
    CrossrefPubMedGoogle Scholar
  • 31 Leonetti JP, Anderson D, Marzo S, Moynihan G. Prevention and management of cerebrospinal fluid fistula after transtemporal skull base surgery. Skull Base 2001; 11 (02) 87-92
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Sanna M, , Rohit, Skinner LJ, Jain Y. Technique to prevent post-operative CSF leak in the translabyrinthine excision of vestibular schwannoma. J Laryngol Otol 2003; 117 (12) 965-968
    CrossrefPubMedGoogle Scholar
  • 33 Khrais TH, Falcioni M, Taibah A, Agarwal M, Sanna M. Cerebrospinal fluid leak prevention after translabyrinthine removal of vestibular schwannoma. Laryngoscope 2004; 114 (06) 1015-1020
    CrossrefPubMedGoogle Scholar
  • 34 Ben Ammar M, Piccirillo E, Topsakal V, Taibah A, Sanna M. Surgical results and technical refinements in translabyrinthine excision of vestibular schwannomas: the Gruppo Otologico experience. Neurosurgery 2012; 70 (06) 1481-1491 , discussion 1491
    CrossrefPubMedGoogle Scholar
  • 35 Goddard JC, Oliver ER, Lambert PR. Prevention of cerebrospinal fluid leak after translabyrinthine resection of vestibular schwannoma. Otol Neurotol 2010; 31 (03) 473-477
    CrossrefPubMedGoogle Scholar
  • 36 Volsky PG, Hillman TA, Stromberg KJ. et al. Hydroxyapatite cement cranioplasty following translabyrinthine approach: long-term study of 369 cases. Laryngoscope 2017; 127 (09) 2120-2125
    CrossrefPubMedGoogle Scholar
  • 37 Roche PH, Pellet W, Moriyama T, Thomassin JM. Translabyrinthine approach for vestibular schwannomas: operative technique. Prog Neurol Surg 2008; 21: 73-78
    CrossrefPubMedGoogle Scholar
  • 38 Arriaga MA, Chen DA, Burke EL. Hydroxyapatite cement cranioplasty in translabyrinthine acoustic neuroma surgery-update. Otol Neurotol 2007; 28 (04) 538-540
    CrossrefPubMedGoogle Scholar
  • 39 Wiet RJ, Mamikoglu B, Hoistad D, Battista R. A technique to prevent cerebrospinal fluid leakage after translabyrinthine approach. Laryngoscope 2000; 110 (07) 1234-1236
    CrossrefPubMedGoogle Scholar
  • 40 Fishman AJ, Marrinan MS, Golfinos JG, Cohen NL, Roland Jr JT. Prevention and management of cerebrospinal fluid leak following vestibular schwannoma surgery. Laryngoscope 2004; 114 (03) 501-505
    CrossrefPubMedGoogle Scholar
  • 41 Fayad JN, Schwartz MS, Slattery WH, Brackmann DE. Prevention and treatment of cerebrospinal fluid leak after translabyrinthine acoustic tumor removal. Otol Neurotol 2007; 28 (03) 387-390
    CrossrefPubMedGoogle Scholar
  • 42 Cooper MW, Ward BK, Sharon J, Francis HW. Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa. World J Otorhinolaryngol Head Neck Surg 2021; 7 (02) 82-87
    CrossrefPubMedGoogle Scholar
  • 43 Chen TC, Maceri DR, Levy ML, Giannotta SL. Brain stem compression secondary to adipose graft prolapse after translabyrinthine craniotomy: case report. Neurosurgery 1994; 35 (03) 521-523 , discussion 523–524
    CrossrefPubMedGoogle Scholar
  • 44 Liu JK, Saedi T, Delashaw Jr JB, McMenomey SO. Management of complications in neurotology. Otolaryngol Clin North Am 2007; 40 (03) 651-667 , x–xi
    CrossrefPubMedGoogle Scholar
  • 45 Boghani Z, Choudhry OJ, Schmidt RF, Jyung RW, Liu JK. Reconstruction of cranial base defects using the Medpor Titan implant: cranioplasty applications in acoustic neuroma surgery. Laryngoscope 2013; 123 (06) 1361-1368
    CrossrefPubMedGoogle Scholar
  • 46 Hussain A, Ahsan F. The use of hydroxyapatite cement and a pericranial/deep temporal fascia graft for cranioplastic reconstruction of translabyrinthine craniectomy defects. Ear Nose Throat J 2005; 84 (02) 86-92 , 89–90, 92
    CrossrefPubMedGoogle Scholar
  • 47 Manjila S, Weidenbecher M, Semaan MT, Megerian CA, Bambakidis NC. Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh-hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma. J Neurosurg 2013; 119 (01) 113-120
    CrossrefPubMedGoogle Scholar
  • 48 Hunter JB, Sweeney AD, Carlson ML. et al. Prevention of postoperative cerebrospinal fluid leaks after translabyrinthine tumor resection with resorbable mesh cranioplasty. Otol Neurotol 2015; 36 (09) 1537-1542
    CrossrefPubMedGoogle Scholar
  • 49 Freeman MH, Cass ND, Berndt DM. et al. Association of postoperative sigmoid sinus occlusion and cerebrospinal fluid leak in translabyrinthine surgery. Otolaryngol Head Neck Surg 2023; 168 (03) 435-442
    CrossrefPubMedGoogle Scholar
  • 50 Bambakidis NC, Munyon C, Ko A, Selman WR, Megerian CA. A novel method of translabyrinthine cranioplasty using hydroxyapatite cement and titanium mesh: a technical report. Skull Base 2010; 20 (03) 157-161
    Article in Thieme ConnectPubMedGoogle Scholar
  • 51 Sekhar LN, Mai JC. Dural repair after craniotomy and the use of dural substitutes and dural sealants. World Neurosurg 2013; 79 (3-4): 440-442
    CrossrefPubMedGoogle Scholar
  • 52 Lindberg K, Badylak SF. Porcine small intestinal submucosa (SIS): a bioscaffold supporting in vitro primary human epidermal cell differentiation and synthesis of basement membrane proteins. Burns 2001; 27 (03) 254-266
    CrossrefPubMedGoogle Scholar
  • 53 Wareing MJ, O'Connor AF. Long-term middle-ear effects of middle-ear/eustachian tube packing after translabyrinthine surgery. J Laryngol Otol 2000; 114 (06) 429-431
    CrossrefPubMedGoogle Scholar
  • 54 Angeli RD, Piccirillo E, Di Trapani G, Sequino G, Taibah A, Sanna M. Enlarged translabyrinthine approach with transapical extension in the management of giant vestibular schwannomas: personal experience and review of literature. Otol Neurotol 2011; 32 (01) 125-131
    CrossrefPubMedGoogle Scholar
  • 55 Russel A, Hoffmann CP, Nguyen DT, Beurton R, Parietti-Winkler C. Can the risks of cerebrospinal fluid leak after vestibular schwannoma surgery be predicted?. Otol Neurotol 2017; 38 (02) 248-252
    CrossrefPubMedGoogle Scholar
  • 56 Ölander C, Gudjonsson O, Kinnefors A, Laurell G, Edfeldt L. Complications in translabyrinthine surgery of vestibular schwannoma. Acta Otolaryngol 2018; 138 (07) 639-645
    CrossrefPubMedGoogle Scholar
  • 57 Brennan JW, Rowed DW, Nedzelski JM, Chen JM. Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach on incidence and response to treatment. J Neurosurg 2001; 94 (02) 217-223
    CrossrefPubMedGoogle Scholar
  • 58 Zhang Z, Wang Z, Huang Q, Yang J, Wu H. Removal of large or giant sporadic vestibular schwannomas via translabyrinthine approach: a report of 115 cases. ORL J Otorhinolaryngol Relat Spec 2012; 74 (05) 271-277
    CrossrefPubMedGoogle Scholar
  • 59 Charpiot A, Tringali S, Zaouche S, Ferber-Viart C, Dubreuil C. Perioperative complications after translabyrinthine removal of large or giant vestibular schwannoma: Outcomes for 123 patients. Acta Otolaryngol 2010; 130 (11) 1249-1255
    CrossrefPubMedGoogle Scholar
  • 60 Kawashima A, Sandler CM, Ernst RD, Tamm EP, Goldman SM, Fishman EK. CT evaluation of renovascular disease. Radiographics 2000; 20 (05) 1321-1340
    CrossrefPubMedGoogle Scholar
  • 61 Das JM. Bone wax in neurosurgery: a review. World Neurosurg 2018; 116: 72-76
    CrossrefPubMedGoogle Scholar
  • 62 Couldwell WT, Chen TC, Weiss MH, Fukushima T, Dougherty W. Cranioplasty with the Medpor porous polyethylene flexblock implant. Technical note. J Neurosurg 1994; 81 (03) 483-486
    CrossrefPubMedGoogle Scholar
  • 63 Neovius E, Engstrand T. Craniofacial reconstruction with bone and biomaterials: review over the last 11 years. J Plast Reconstr Aesthet Surg 2010; 63 (10) 1615-1623
    CrossrefPubMedGoogle Scholar
  • 64 Cueva RA, Mastrodimos B. Approach design and closure techniques to minimize cerebrospinal fluid leak after cerebellopontine angle tumor surgery. Otol Neurotol 2005; 26 (06) 1176-1181
    CrossrefPubMedGoogle Scholar
  • 65 Ackerman PD, Hammers R, Ibrahim T, Origitano TC. The use of abdominal free fat for volumetric augmentation and primary dural closure in supratentorial skull base surgery: managing the stigma of a temporal defect. J Neurol Surg B Skull Base 2012; 73 (02) 139-144
    Article in Thieme ConnectPubMedGoogle Scholar
  • 66 Kerr RG, Hearst MJ, Samy RN. et al. Delayed extrusion of hydroxyapatite cement after transpetrosal reconstruction. Neurosurgery 2009; 64 (03) 527-531 , discussion 531–532
    CrossrefPubMedGoogle Scholar
  • 67 CRANIAL Consortium. Machine learning driven prediction of cerebrospinal fluid rhinorrhoea following endonasal skull base surgery: a multicentre prospective observational study. Front Oncol 2023; 13: 1046519
    CrossrefPubMedGoogle Scholar
  • 68 Selesnick SH, Liu JC, Jen A, Newman J. The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery. Otol Neurotol 2004; 25 (03) 387-393
    CrossrefPubMedGoogle Scholar
  • 69 Horsfall HL, Moudgil-Joshi J, Burton O. et al Skull base repair following resection of vestibular schwannoma: a systematic review (Part 1: The Retrosigmoid Approach). J Neurol Surg B Skull Base 2024; . Epub ahead of print. DOI: 10.1055/a-2222-0184.
    Article in Thieme ConnectPubMedGoogle Scholar