• Mari Kusumi, Takanori Fukushima, Hamidreza Aliabadi, Ankit I Mehta, Shusaku Noro, Charles L Rosen, and Kiyotaka Fujii.
• Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA. kusumi@med.kitasato-u.ac.jp
• Neurosurgery. 2012 Jun 1;70(2 Suppl Operative):264-9.

BackgroundAlthough 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%.ObjectiveTo describe an innovative technique of watertight dural closure with a long microplate-bridge technique for the combined petrosal approach.MethodsWe 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.ResultsThe 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%).ConclusionWe recommend this safe and simple closure technique during skull base surgery.

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