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Neurosurgery. 2012 Jun;70(2 Suppl Operative):264-9. doi: 10.1227/NEU.0b013e3182356269.

Microplate-bridge technique for watertight dural closures in the combined petrosal approach.

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  • 1Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA. kusumi@med.kitasato-u.ac.jp



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%.


To describe an innovative technique of watertight dural closure with a long microplate-bridge technique for the combined petrosal approach.


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.


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%).


We recommend this safe and simple closure technique during skull base surgery.

[PubMed - indexed for MEDLINE]
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