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<p>Cerebrospinal fluid (CSF) leakage represents a significant postoperative complication following vestibular schwannoma surgery, with rates varying considerably across different surgical approaches and technical modifications. The optimal surgical approach to minimize CSF leakage remains controversial. To review and compare cerebrospinal fluid leakage rates across different surgical approaches for vestibular schwannoma resection, with particular focus on retrosigmoid and translabyrinthine techniques and their modifications. A review was conducted following PRISMA 2020 guidelines. Clinical trials comparing surgical approaches for vestibular schwannoma with reported CSF leakage outcomes were included. Studies were screened based on predetermined criteria including patient population, intervention type, study design, outcome reporting, surgery type, and sample size. Data extraction focused on study design, participant characteristics, surgical approaches, CSF leakage rates, complications, and technical modifications. Five clinical trials met inclusion criteria, encompassing 436 patients. Four studies utilized retrosigmoid approaches while one employed translabyrinthine technique. Standard retrosigmoid approaches demonstrated CSF leak rates of 12%, while modified retrosigmoid incisions (C-shaped and modified Dandy) reduced rates to 4% and 0% respectively. The translabyrinthine approach showed a 12% CSF leak rate. Modified incision techniques consistently demonstrated superior outcomes compared to standard approaches, with C-shaped incisions reducing leak rates from 12 to 4% and modified Dandy incisions eliminating leaks entirely compared to 5% with classical linear incisions. Modified retrosigmoid incision techniques significantly reduce cerebrospinal fluid leakage rates compared to standard approaches. The C-shaped and modified Dandy incisions demonstrate particular efficacy in minimizing postoperative CSF complications. No direct comparative studies between retrosigmoid and translabyrinthine approaches were identified, highlighting a significant research gap.</p>

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Comparison of Cerebrospinal Fluid Leakage Rates Across Surgical Approaches for Vestibular Schwannoma: A Review

  • 期刊论文

  • 发表日期：

    2025年8月30日

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  • G. Deepa,
  • B. H. Shrikrishna

摘要

Cerebrospinal fluid (CSF) leakage represents a significant postoperative complication following vestibular schwannoma surgery, with rates varying considerably across different surgical approaches and technical modifications. The optimal surgical approach to minimize CSF leakage remains controversial. To review and compare cerebrospinal fluid leakage rates across different surgical approaches for vestibular schwannoma resection, with particular focus on retrosigmoid and translabyrinthine techniques and their modifications. A review was conducted following PRISMA 2020 guidelines. Clinical trials comparing surgical approaches for vestibular schwannoma with reported CSF leakage outcomes were included. Studies were screened based on predetermined criteria including patient population, intervention type, study design, outcome reporting, surgery type, and sample size. Data extraction focused on study design, participant characteristics, surgical approaches, CSF leakage rates, complications, and technical modifications. Five clinical trials met inclusion criteria, encompassing 436 patients. Four studies utilized retrosigmoid approaches while one employed translabyrinthine technique. Standard retrosigmoid approaches demonstrated CSF leak rates of 12%, while modified retrosigmoid incisions (C-shaped and modified Dandy) reduced rates to 4% and 0% respectively. The translabyrinthine approach showed a 12% CSF leak rate. Modified incision techniques consistently demonstrated superior outcomes compared to standard approaches, with C-shaped incisions reducing leak rates from 12 to 4% and modified Dandy incisions eliminating leaks entirely compared to 5% with classical linear incisions. Modified retrosigmoid incision techniques significantly reduce cerebrospinal fluid leakage rates compared to standard approaches. The C-shaped and modified Dandy incisions demonstrate particular efficacy in minimizing postoperative CSF complications. No direct comparative studies between retrosigmoid and translabyrinthine approaches were identified, highlighting a significant research gap.