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Microplate-Bridge Technique for Watertight Dural Closures in the Combined Petrosal Approach

BACKGROUND: Although the combined petrosal approach has significant advantages for medium to large petroclival lesions, it carries the risk of a few major complications. The cerebrospinal fluid leak rate with this approach has been reported to be as high as 15%. OBJECTIVE: To describe an innovative technique of watertight dural closure with a long microplate-bridge technique for the combined petrosal approach. METHODS: We describe our method of watertight dural closures with the microplate-bridge technique for combined petrosal approaches using cadaveric heads and clinical cases. We review our postoperative outcomes in respect to cerebrospinal fluid leaks. RESULTS: The technique involves a fascial graft to the presigmoid-subtemporal defect, fixated with a long microtitanium plate over the cranial base side. The fascial graft is augmented by covering it with an abdominal fat graft and a vascularized pericranial flap. This technique was performed in 23 patients after surgical resection of petroclival meningiomas with only 1 postoperative cerebrospinal fluid leak (4.4%). CONCLUSION: We recommend this safe and simple closure technique during skull base surgery.