Cerebrospinal fluid leakage in patients after retrosigmoid approach for tumor resection: systematic review of techniques to manage dural closure and cranial reconstruction

Objective: This systematic review aims to assess the effectiveness of dural and bony reconstruction techniques in preventing cerebrospinal fluid (CSF) leakage following retrosigmoid approaches for tumor resection. It focuses specifically on oncological cases, excluding studies on solely microvascular decompression, to provide targeted insights. Method: The review followed PRISMA guidelines and included clinical studies published between 2000 and 2024, sourced from MEDLINE/PUBMED and Ovid Embase. Studies focusing on retrosigmoid approaches for tumor resections with detailed reports on dural and cranial reconstruction were selected. A total of 22 studies involving 3,879 cases met the inclusion criteria. Results: CSF leakage occurred in 7% of cases overall (269 patients), with infection rates at 1.5% (60 patients). Watertight dural closure was achieved in 93% of cases. The use of heterologous patches was common in more than one-third of cases overall (37%), while autologous materials were employed in 33% of cases. Bone cement was used in 21% of cases, and bone wax in 59%. The lowest leakage rates were associated with the use of bone cement and multilayer closure techniques. Conclusion: The review highlights that the combination of heterologous or autologous dural patches with bone cement significantly reduces CSF leakage rates. Simpler techniques without comprehensive reconstruction are associated with higher leakage and infection risks. These findings can inform surgical practices for better outcomes in retrosigmoid approach for tumor resections.