2026 Proffered Presentations
S263: IMPACT OF WOUND CLOSURE TECHNIQUE ON POSTOPERATIVE OUTCOMES FOLLOWING CEREBELLOPONTINE ANGLE TUMOR RESECTION: A RETROSPECTIVE COHORT STUDY
Brandon Zsigray, MD1; Maria I Burritt St. Angelo, BS1; Andrew Ghannad, BS1; Angeli Mittal, MS2; Caitlin Kacena, BS2; Michael Egozi, BS2; Andre Payman, MD1; Zachary Uram, MD1; Vikram Prabhu, MD1; Douglas E Anderson, MD1; Anand Germanwala, MD1; 1Loyola University Medical Center; 2Loyola Stritch School of Medicine
INTRODUCTION: Surgical resection of cerebellopontine angle (CPA) tumors often requires a substantial dural opening and wide exposure of the skull base. These technically challenging approaches are associated with varying instances of post-operative wound closure complications such as cerebrospinal fluid (CSF) leak (4-17%), pseudomeningocele development (5-12%), wound infection (2-6%), and wound dehiscence (3-5%). Various CPA wound closure implants and methods may be used to mitigate these risks, though there is limited evidence to support individual closure practices. This study evaluates the relationship between wound closure techniques and postoperative outcomes in patients undergoing microsurgical resection of CPA tumors, and identifies surgical strategies that may reduce the risk of CSF and wound-related complications.
METHODS: A retrospective review of our single institutional series over a 6-year period identified patients who underwent surgical resection of a neoplasm originating from or extending into the CP angle and had at least one outpatient follow-up visit. This yielded a cohort of 239 patients across 3 operating surgeons. As wound and necessary closure techniques typically vary greatly by surgical approach, entries were further subcategorized by approach type: presigmoid (n=82), retrosigmoid (n=123), and combined (n=34). Our primary endpoint was the incidence of common postoperative complications (CSF leaks, pseudomeningocele, wound dehiscence, and wound infection) associated with surgical approach. Secondary endpoints further examined these complications in the context of surgical wound closure implant (scalp drains, muscle grafts, biologic glue, dural substitutes, titanium plating), controlling for variables determined statistically significant in initial univariate analysis. We further gathered data on the management of these complications to determine if type of implant affected the need for additional, invasive treatment. Data were analyzed using one-way and Welch’s ANOVA tests, Chi-squared tests and Fisher’s exact tests, and multivariate logistic regression.
RESULTS: Our findings demonstrated trends in CSF-related complications, with a reduction in pseudomeningocele development after scalp drain placement reaching statistical significance in the retrosigmoid cases. Interestingly, there was an opposite yet non-significant increase in CSF-related complications following scalp drain placement in presigmoid cases. Significantly, the use of titanium plating was associated with reduced rates of postoperative CSF-related complications, particularly pseudomeningocele development (OR 0.327, 95% CI 0.117-0.832, p=0.016), and the use of dural substitutes was associated with increased rates of wound infection across all surgeries (OR 3.641, 95% CI 0.863-14.168, p=0.040). Ultimately, none of the studied implants resulted in a statistically significant effect on the need for CSF diversion or reoperation.
CONCLUSION: These findings suggest that wound closure technique influences outcomes of CPA resections, identifying titanium plating as reducing rates of postoperative CSF complications and dural substitutes increasing chances of wound infection. Though a single study may not provide sufficient evidence to determine the safest and most efficacious practices for CPA lesions, future directions exploring individual indications may support a strong meta-analysis on the topic to tailor these techniques for patient-specific needs and guide a decision-making process that involves the use of some costly wound repair products.
