Objective: To investigate the effectiveness of a modification of the retrosigmoid (RS) approach in reducing the rate of postoperative cerebrospinal fluid (CSF) leak after vestibular schwannoma surgery.
Patients: Of 1,499 vestibular schwannomas operated on at the Gruppo Otologico between April 1987 and July 2006, 84 cases have been selected, all of them treated through the RS approach.
Interventions: The classic approach was adopted in the first 21 cases, whereas a retrolabyrinthine bone removal was added in the last 56.
Main outcome measure: Percentage of postoperative CSF leak.
Results: The overall percentage of postoperative CSF leak was 8.3%. However, the percentage decreased from 21.4 to 1.8% after the surgical modification, with a single leak recorded in the second group. The only drawback was an additional surgical time of 40 minutes.
Conclusion: Extension of the classic RS that addressed retrolabyrinthine air cells is associated with a significant reduction in CSF leak manifesting rhinorrhea.