The multidisciplinary team at the USC Acoustic Neuroma Center at Keck Medical Center of USC has the experience and capability to make swift diagnoses and clinical decisions regarding rare complications, in order to optimize the outcomes for our patients. One particular complication our team has expertise with is the complex technique used to prevent cerebrospinal fluid (CSF) leaks.

Produced within the brain, CSF is a clear bodily fluid that passes through and out of the ventricular system bathing and cushioning the brain and spinal cord. This vital fluid serves many functions, both physical and chemical, within the central nervous system. A person’s CSF is constantly being produced and reabsorbed — each day, enough is created to completely replace the supply three times.

Surgical intervention for acoustic neuromas requires accessing the subarachnoid space of the brain where CSF circulates. Reconstruction of the surgical site is necessary in order to prevent CSF leakage after acoustic neuroma surgery.

Surgical reconstruction after removal of an acoustic neuroma typically involves several steps. First, the coverings of the brain are sutured back together in an attempt to create a watertight seal. In cases where this is not possible, a combination of materials is used. An autologous graft — typically made of subcutaneous fat and/or fibrous tissue enclosing a muscle or organ, which is obtained from the patient’s abdomen during surgery — is used to fill in the space created when the bone and acoustic neuroma tumor were removed. Finally, the graft material is held in place, and the skull is reconstructed with a titanium mesh.

By Jonathan J. Russin, MD
Assistant Professor of Clinical Neurological Surgery, Department of Neurosurgery

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