Cerebrospinal fluid fistula after microvascular decompression for trigeminal neuralgia

see Microvascular decompression complications.

Current treatments comprise reducing cerebrospinal fluid pressure by continuous lumbar drainage or repeated spinal taps and administering antibiotics to prevent infections 1). Failure of these treatments finally requires additional surgical intervention. Even after these treatments, fatal situations, such as pseudomeningocele, meningitis, and abscess formation, may complicate the postoperative course and lead to permanent deficits.

To prevent Cerebrospinal fluid fistula leakage after MVD, it has been highly emphasized by Peter J. Jannetta to ensure watertight dural closure 2).

Additionally, primary dural closure (primary reapproximation and suturing of the dural edges) is the best seal without the introduction of autologous grafts of fat or artificial dural substitutes 3)

Schiariti M, Acerbi F, Broggi M, Tringali G, Raggi A, Broggi G, Ferroli P. Two alternative dural sealing techniques in posterior fossa surgery: (Polylactide-co-glycolide) self-adhesive resorbable membrane versus polyethylene glycol hydrogel. Surg Neurol Int. 2014 Dec 3;5:171. doi: 10.4103/2152-7806.146154. PMID: 25593755; PMCID: PMC4287912.
McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK. Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg. 1999 Jan;90(1):1-8. doi: 10.3171/jns.1999.90.1.0001. PMID: 10413149.
Moskowitz SI, Liu J, Krishnaney AA. Postoperative complications associated with dural substitutes in suboccipital craniotomies. Neurosurgery. 2009 Mar;64(3 Suppl):ons28-33; discussion ons33-4. doi: 10.1227/01.NEU.0000334414.79963.59. PMID: 19240570.
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