CSF Leak after Translabyrinthine Excision of Vestibular Schwannoma: Three Key Steps to Minimize the Incidence

Objective: To describe our technique to reduce the incidence of CSF leak after translabyrinthine excision of vestibular schwannoma. Design: Retrospective review of prospectively collected data. Patients: All patients that underwent translabyrinthine excision of vestibular schwannoma between March 2009 and January 2012. Methods: After performing a translabyrinthine excision of the tumor, three key steps are undertaken: (1) The eustachian tube opening is force plugged using sequential pieces of bone wax. (2) The petrosal cavity is filled with fat only. (3) Continuous CSF lumbar drainage is utilized for 48 hours postoperatively. Results: Twenty-five patients underwent a translabyrinthine excision of vestibular schwannoma during a 34-month period. There was no incidence of major CSF leakage (requiring a return to the operating theater). One patient had temporary CSF leakage in the immediate postoperative period that settled using reinsertion of the lumbar drain. None of the patients required any further intervention. Conclusion: The technique described is a simple and effective way in preventing CSF leak after translabyrinthine excision of vestibular schwannoma.