Introduction: Posterior fossa surgery traditionally implies permanent bone removal. Although suboccipital craniectomy offers an excellent exposure, it could lead to complications. Thus, in many centers, craniotomy is considered a valuable alternative to craniectomy. The objective of this study was to compare the post-operative complications after craniotomy or craniectomy for posterior fossa surgery. Thus, in many centers, craniotomy is considered a valuable alternative to craniectomy.
Methods: Data were prospectively collected for a consecutive series of patients who underwent either posterior fossa craniotomy or craniectomy for tumor resection. Patients were divided into two groups based on the surgical procedure performed and safety, complication rates and length of hospitalization were analyzed. Craniotomies were performed with Control-Depth-Attachment drill and chisel, while craniectomies with perforator and rongeurs.
Results: One-hundred-fifty-two patients were included in the study (craniotomy n=100, craniectomy n=52). No dural damage was detected after bone removal in both groups. Total complication rate related to the technique itself was 7% for the craniotomy group and 32.6% for the craniectomy group (p<0.0001). Pseudomeningocele occurred in 4% vs. 19.2% (p=0.0009), CSF leak in 2% vs. 11.5% (p=0.006) and wound infection in 1% vs. 1.9% (p=0.33), respectively. Post-operative hydrocephalus, a multi-factorial complication which could affect our results, was also calculated and occurred in 4% of the craniotomy vs. 9.6% of the craniectomy group (p=0.08). The mean length of in-hospital stay was 9.3 days for the craniotomy group and 11.8 days for the craniectomy group (p=0.10).
Conclusions: The present study suggests that fashioning a suboccipital craniotomy is as effective and safe as performing a craniectomy; both procedures showed similar results in preserving dural integrity, while post-operative complications were fewer when a suboccipital craniotomy was performed.
Patient Care: We believe that performing a craniotomy instead of a craniectomy will lead to less complications in posterior fossa surgery for brain tumors.
Learning Objectives: By the conclusion of this session, participants should: 1)consider craniotomy as safe as craniectomy to access the posterior fossa; 2) take into account a novel surgical technique to create a suboccipital bone flap associated to minimal bone loss.