Comparative Analysis of Autograft- and Xenograft-Based Spinal Fluid Leak Prevention after Translabyrinthine Resection of Cerebellopontine Angle Tumors

Objective: To compare the use of porcine small intestine submucosal grafts (PSISG, Biodesign) and standard autologous material (fascia) for the prevention of cerebrospinal fluid (CSF) leak after surgical resection of cerebellopontine (CPA) angle tumors.

Setting: Tertiary skull base center.

Methods: Retrospective chart review. After IRB approval, we performed a retrospective cohort study evaluating cerebrospinal fluid (CSF) leak in patients who underwent translabyrinthine (TL) surgical resection for CPA tumors using either fascia autograft or porcine small intestinal submucosal grafts (PSISG, Biodesign). Demographics were summarized with descriptive statistics. The Kruskal–Wallis test compared the cohorts. Single-predictor binary logistic regressions evaluated the association of covariates with outcomes.

Results: Seventy-seven patients (mean age: 49 years; range: 17–73; female = 51 [66%]) underwent TL surgical resection of CPA tumors. Composite repair consisting of dural substitute, adipose tissue, and either fascia autograft (56 patients; 73%) or PSISG (Biodesign) (21 patients; 27%) from 2016 to 2018 were evaluated. Patients were followed up for a minimum of 6 months after surgery. The mean tumor size was 2.3 cm (range: 0.4–6.1) and there was no significant size difference between the cohorts (p = 0.2028). The most common pathologic diagnosis was vestibular schwannoma (n = 71, 92%), followed by epidermoid (n = 2, 2.6%), meningioma (n = 2, 2.6%), and facial nerve schwannoma (n = 2, 2.6%). All tumors were excised via TL approach. There were seven overall postoperative leaks (9.1%) of which 3 (5.4%) required operative repair. One leak (4.8%) occurred in the Biodesign cohort while six leaks (10.7%) occurred in the autograft cohort (OR: 0.417, 95% CI: 0.047–3.684, p = 0.4312). Size was not associated with postoperative leak (OR: 0.782, 95% CI: 0.310–1.975, p = 0.634). One pseudomeningocele (4.8%) was identified in the Biodesign cohort, while five pseudomeningoceles (8.9%) were identified in the autograft cohort (OR: 0.510, 95% CI: 0.056–4.642, p = 0.5501). No operative repairs occurred in the Biodesign cohort, while three operative repairs (5.4%) occurred in the fascia autograft cohort.

Conclusion: Porcine small intestinal submucosal grafts (Biodesign) appear to provide an effective barrier as a component of complex skull base reconstruction after surgical extirpation of CPA tumors. Biodesign performs well in preventing CSF leaks and appears noninferior to autologous tissue in skull base reconstruction.