Introduction: Since Dandys original report of cerebrospinal fluid (CSF) otorhinorrhea following surgery for acoustic neurinoma, the problem of CSF leakage with its inherent risk of meningitis has been a troublesome and frequent problem. we present our surgical technique for prevention of postoperative CSF leak & outcomes

Methods: We retrospectively reviewed our Skullbase database database for all patients undergoing a posterior fossa craniectomy for vestibular schwannoma. Our closure technique has evolved from the senior authors experience to comprise of craniotomy with preservation of free bone flap & bone dust, drilling of mastoid air cells & packing with bone wax & bone dust, dural closure with dural substitute & TISSEAL. Most importantly we place a gravity wound drain below the muscle layer for 3-5 days.

Results: 224 patients (age range 16 - 80 years) underwent retrosigmoid craniectomy for vestibular schwannoma with postoperative csf leak in 14 patients ( 7.6%). 4 patients required VP Shunt for associated hydrocephalus.

Conclusions: Meticulous closure & the use of a gravity drain minimise CSF leak rate in acoustic neuroma surgery

Patient Care: Our technique will reduce the risk of postoperative CSF leak in vestibular schwannoma surgery

Learning Objectives: Recognition & prevention of CSF Fistulae in surgery for vestibular schwannoma. Complication avoidance.

References: Dandy WE: Treatment of rhinorrhea and otorrhea. Arch Surg 49:75–85, 1944. Symon L, Pell MF: Cerebrospinal fluid rhinorrhea following acoustic neurinoma surgery. Technical note. J Neurosurg 74:152–153, 1991 . Incidence of cerebrospinal fluid leak after microsurgical removal of vestibular schwannomas. Bani A, Gilsbach JM. Acta Neurochir (Wien). 2002 Oct;144(10):979-82;discussion 982. Approach design and closure techniques to minimize cerebrospinal fluid leak after cerebellopontine angle tumor surgery. Cueva RA, Mastrodimos B. Otol Neurotol. 2005 Nov;26(6):1176-81.