2026 Proffered Presentations
S100: PARALLEL POSTAURICULAR INCISIONS: WOUND OUTCOMES OF TRANSMASTOID REPAIR FOR CSF LEAK AFTER RETROSIGMOID VESTIBULAR SCHWANNOMA RESECTION
Derrick Obiri - Yeboah; John P Marinelli; Alex Pais; Danielle D Dang; Christine Lohse; Jim R Dornhoffer; Colin Driscoll; Matthew L Carlson; Maria Peris Celda; Michael J Link; Brian Neff; Jamie Van Gompel; Mayo Clinic
Background: Cerebrospinal fluid (CSF) leak after retrosigmoid vestibular schwannoma resection can be a challenging complication. Historically, creation of a separate, new parallel postauricular incision for transmastoid CSF leak repair following an index retrosigmoid incision has been discouraged due to concerns of wound breakdown and infection, with surgeons often reopening the initial retrosigmoid incision for repair. However, there are limited data to support this position given that a smaller mastoid incision may be sufficient. This study evaluated wound healing outcomes in patients who underwent transmastoid repair with or without a new postauricular incision for persistent CSF leak after retrosigmoid surgery.
Methods: A retrospective review was performed of 28 patients who underwent transmastoid repair for persistent postoperative CSF leak following retrosigmoid craniotomy for vestibular schwannoma from 2000 through 2025. Patient demographics, operative details, timing of leak diagnosis and repair, wound complications, readmissions, antibiotic use, and culture results were analyzed.
Results: The mean age of the cohort was 49 years, 64% were male, and the mean BMI was 28.8 kg/m². Mastoid obliteration was performed in 96% of patients with fat graft used in 89%. A new postauricular incision was created in 96% of patients. Median time from retrosigmoid surgery to leak diagnosis was 12 days (IQR 4-68), and median time from leak diagnosis to repair was 2 days (IQR 1-5).
Wound healing outcomes were excellent. One patient with a new mastoid incision (3.7%) developed a superficial wound abscess, with no cases of dehiscence or flap necrosis. At a median follow-up of 31 months (IQR 2.9-83.6), all 28 patients had healed wounds. CSF leak recurred in 2 patients (7.1%) and 3 patients (10.7%) required return to the operating room: 2 for recurrent leak repair and 1 for wound debridement.
Conclusion: Creation of a new postauricular incision for transmastoid CSF leak repair after retrosigmoid vestibular schwannoma resection was not associated with wound healing complications. On long-term follow-up, all patients achieved durable wound healing. These findings support transmastoid repair with mastoid obliteration as a safe and effective strategy for managing persistent CSF leaks in this context.