Low-Cost Reconstruction Using a “Woven” Technique for Middle Fossa Defects After Anterior Petrosectomy: Technical Note
DOI:
https://doi.org/10.59156/aqq0fn65Keywords:
Middle fossa, Neurosurgery, Petrosectomy, Skull baseAbstract
Background: middle fossa surgery, particularly anterior petrosectomy, represents one of the most demanding approaches to the skull base. One of its most relevant complications is cerebrospinal fluid (CSF) leakage, favored by communication of the surgical defect with the temporal bone air cells and, in some cases, the Eustachian tube. Although multiple reconstructive strategies based on autologous tissues and synthetic materials have been described, these options present limitations related to increased morbidity, longer operative time, high costs, or limited availability.
Objectives: to describe a hybrid reconstructive technique for dural and osseous defect closure after anterior petrosectomy, aimed at preventing cerebrospinal fluid leakage.
Technique description: after lesion resection and meticulous hemostasis, all opened mastoid or petrous air cells are systematically sealed using bone wax. Reconstruction is performed in three layers using hemostatic gelatin sponge and autologous arterial blood. The sponges are arranged in a crosswise woven pattern covering the surgical corridor. Subsequently, 10–15 ml of arterial blood is applied, allowing clot formation integrated into the sponge, which creates an immediate fibrin seal. The bone flap is repositioned according to standard technique, without routine use of lumbar drainage.
Conclusion: the described technique represents a simple, reproducible, and low-cost alternative for surgical corridor closure after anterior petrosectomy. This is a valid option for CSF leak prevention in middle fossa surgery.
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