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Four layer onlay stacking repair of dura preventing cerebrospinal fluid leakage in microvascular decompression
J Korean Skull Base Soc 2023;18(2):105-112
Published online October 31, 2023
© 2023 Korean Skull Base Society.

Ho Che Jung, Hyun Seok Lee, Kyung Rae Cho, Kwan Park

Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
Correspondence to: Kwan Park
Received August 17, 2023; Revised September 12, 2023; Accepted September 18, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Cerebrospinal fluid (CSF) leakage is one of major complication following cranial surgery. Many studies have been introducing surgical methods to prevent CSF leakage. Technique applying dural substitutes are being studied for its efficacy for preventing CSF leakage. We introduce four layer onlay stacking repair (FLOSR), effective dural closing technique for preventing CSF leakage, while avoiding application of foreign material intradural space.
Materials and Methods: Retrospective analysis of patients undergone microvascular decompression (MVD) surgery for hemifacial spasm (HFS) and trigeminal neuralgia (TN) by a single surgeon in single center between September 2020 and September 2022 was done. MVD was done by retromastoid suboccipital approach. Number of patients who had CSF leakage, symptoms occurred by CSF leakage and treatment done for the patients were collected.
Results: In this study, 355 patients underwent MVD for HFS and TN and 4 were excluded. Three patients of selected 351 patients who underwent MVD for HFS were suspected for CSF leakage which counts for approximately 0.9% of patients. All patients suspected for CSF leakage underwent MVD for HFS (3 of 3, 100%). Continuous lumbar drainage of 180–240 cc per day for 5 days was done and every patient had symptom improvement.
Conclusions: FLOSR provided an effective method intra-operatively in preventing and lowering risk of severe CSF leakage after craniotomy by RMSOC (retromastoid suboccipital craniotomy) approach without the risk of placing foreign materials inside dura.
Keywords : Cerebrospinal fluid leakage, Microvascular decompression, Hemifacial spasm, Trigeminal neuralgia

October 2023, 18 (2)
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