Vascularized Mastoid Bone Flap Cranioplasty after Translabyrinthine Vestibular Schwannoma Surgery

Objective: Cerebellospinal fluid (CSF) leak and postauricular deformity can be significant problems in patients after translabyrinthine excision of vestibular schwannomas (VS). We describe a novel technique of cranioplasty using a vascularized mastoid bone flap in combination with abdominal fat graft.

Study Design: Retrospective study.

Results: Seventeen patients who underwent cranioplasty with cortical mastoid bone flap after a translabyrinthine VS excision were evaluated with a minimum follow-up of 12 months. None of the subjects had a CSF leak. The measured pinna projections between the operated and non-operated sides had a mean difference of 0.80 mm (±1.70), which is not statistically significant (p > 0.05). The mean depth of the postauricular depressions was 1.38 mm (±0.93). Over the same period a group of 10 patients underwent translabyrinthine VS surgery without a cranioplasty. In this group, there was a significant difference in mean pinna underprojections on the operated sides compared to the non-operated sides of 4.71 mm (±1.53). In addition, the retroauricular depressions had a mean depth of 2.92 mm (±1.21) in this group of patients, which is significantly deeper than those in patients who have undergone cranioplasty.

Conclusions: Our early experience shows that vascularized mastoid cortical bone flap cranioplasty after translabyrinthine VS excision is a simple and effective technique to ameliorate the pinna and retroauricular deformities. Postoperative CSF leak could be minimized without increasing surgical cost, while avoiding the use of alloplastic materials.