Cerebrospinal fluid leak in posterior fossa surgeries with different dural closure methods -a retrospective cohort study

Introduction : CSF leaks are the most common surgical complication in the posterior fossawhich can be minimized with watertight dural closure which can be done either with native available dura and if not available with other materials. Materials and Methods : Aim of the study was to compare the occurrence of CSF leak in posterior fossa surgeries where different dural closure materials are used. This was a 5 year retrospective cohort study, conducted in the department of Neurosurgery, Government medical college, Thrissur, Kerala, India. Results and Discussion : A total of 49 cases were included in the study. The mean age of the study was 44.86 16.99(4 years- 70 years).Out of the 49 cases 18(36.7%) were male patients and 31(63.3%) were female patients. Total posterior fossa procedures are distributed as CP angle tumor excision 27(55.1%), Foramen magnum decompression for chiari malformation 12(24.5%), Other tumors of posterior fossa 7(14.3%) and vascular lesions of posterior fossa 3(6.1%). Out of the total 49 cases 20 (40.85%) are closed with pericranium, 14 cases (28.6%) are closed with primary dura, 9 cases (18.4%) with fascia lata and 6(12.2%)are closed with artificial dural patch. Out of the total 49 procedures 10(20.4%) has CSF leak and no CSF leak detected in 39(79.6%). It is found that cases closed with pericranium has got a significant capacity to decrease the CSF leak 13 (65%) out of 20 cases (a24.43, df=1 p=0.035).Odds ratio found to be 0.21 that gives 79% protection against CSF leak(95% CI=0.047-0.0968). Conclusion : Study concludes that, in cases of posterior fossa surgeries, closure with pericranium has a significant protection against CSF leak. Keywords: Cerebrospinal fluid leak, Posterior fossa surgeries, Dural closure methods.