Multidisciplinary management for watertight surgical closure of pneumatized mastoid breach using fascia lata graft, following neurosurgical retrosigmoid approach: a technical note - 27/07/26
, Olivier Cathelinaud b, Cédric Bernard c, Jean Baptiste Morvan b, d, Arnaud Dagain c, d, Thomas Gaberel e, f, Nathan Beucler cHighlights |
• | Opening the mastoid air cells during the retro-sigmoid approach can lead to serious infectious complications linking to oto-liquorrhea. |
• | Achieving a watertight closure is essential to prevent cerebrospinal fluid leakage and infection. |
• | Revision surgery is technically more demanding due to fibrosis and loss of anatomical landmarks. |
• | A combined neurosurgical and otolaryngological approach improves the safety and effectiveness of mastoid sealing. |
• | The described “sandwich” technique using fascia lata and sealant provides a simple and reproducible solution in high-risk cases of cerebrospinal fluid leakage. |
Abstract |
The retrosigmoid approach is a standard surgical corridor to the posterior fossa but may lead to mastoid air cell opening and subsequent cerebrospinal fluid (CSF) leakage or infectious complications. Achieving durable closure can be challenging, particularly in revision surgery due to inflammatory changes and altered anatomical landmarks.
We report the case of a 76-year-old patient who developed recurrent infectious complications following a right retrosigmoid approach for posterior fossa meningioma. Imaging revealed a subcutaneous abscess associated with persistent mastoid air cell opening. A combined neurosurgical and otolaryngological revision procedure was performed. The mastoid cavity was sealed using autologous bone powder mixed with biological glue and antibiotics, followed by a multilayer closure with fascia lata and surgical adhesive.
This technique provides a simple and reproducible method for watertight mastoid sealing in complex revision cases.
Le texte complet de cet article est disponible en PDF.Keywords : Retrosigmoid approach, Cerebrospinal fluid leak, Watertight closure
Plan
Vol 72 - N° 5
Article 101853- septembre 2026 Retour au numéro
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