Reduced Risk of CSF Leak via Minimally Invasive Approaches in Posterior Fossa Surgeries: 10-Year Experience

Background CSF leaks are one of the postoperative complications after cranial surgeries which can have severe and potentially lethal consequences for the patient. This is particularly true for posterior fossa surgeries. According to various reports, the complication rate is as high as 33%. This is due to the increased intracranial pressure in the posterior fossa and the presence of many basal cisterns. Adequate watertight duraplasty prevents CSF leaks. Therefore, the smaller the dural defect is, the easier it is to achieve a watertight duraplasty. And that in turn depends also on the size of the craniotomy. As minimally invasive posterior fossa surgery has represented the institutional surgical philosophy in our department for many years, we present our long-term experience and CSF leak rates associated with these approaches. Materials We estimated the rate of postoperative CSF leaks in patients operated on for posterior fossa pathologies between 2015 to 2024. We evaluated the gender and age of the patients, the indications for surgery and urgency thereof, the size of a surgical approach, and the method of duraplasty. Results Over a ten-year period, 275 surgeries were performed on the posterior cranial fossa. 118 (42.9% of cases) of the patients were male, 157 (57.1% of the cases) of the patients were female. The mean age was 59 years (Median 59). The following pathologies were identified: acoustic neuromas, cerebellopontine angle meningiomas, trigeminal neuralgia, hemifacial spasm, cerebellar tumors, cerebellar infarction, cerebellar hemorrhages, and rarer pathologies. The mean size of the craniotomy was 2.15 x 1.9 centimeters. In all cases, duraplasty was performed using alloplastic materials. CSF leaks were reported in 6 (2.18 %, 95% CI 1.00–4.68%) cases: 5 (1.82 %, 95% CI 0.78–4.18%) cases of incisional CSF leaks and 1 (0.36 %, 95% CI 0.06–2.03%) non-incisional. All cases of incisional CSF leak required reoperations. Conclusions The use of minimally invasive approaches in posterior fossa surgery may be associated with a low risk of postoperative cerebrospinal fluid leakage. In this context, adequate dural closure can be achieved when the dural defect is limited and appropriate duraplasty techniques are applied.