Use of Porcine Small Intestinal Submucosal Grafts in Skull Base Reconstruction after Resection of Cerebellopontine Angle Tumors

Objective: To evaluate the use of porcine small intestine submucosal grafts as reconstruction material to prevent cerebrospinal fluid (CSF) leak after surgical resection of cerebellopontine angle tumors.

Setting: Tertiary skull base center.

Methods: Retrospective chart review.

Results: Sixteen patients who underwent surgical resection for cerebellopontine angle tumors at a single center with skull base repair using a composite repair of adipose tissue and porcine small intestine submucosal grafts (Biodesign) from 2016 to 2018 were evaluated. Patients were followed up for a minimum of 6 months after surgery. The mean age of patients at the time of surgery was 52.3 years (range: 17–73) and 10 (63%) were female. The mean tumor size in greatest dimension was 2.6 cm (range: 0.9–6.1). The most common pathologic diagnosis was vestibular schwannoma (n = 13, 81%), followed by epidermoid (n = 2, 13%) and meningioma (n = 1, 6%). Fourteen tumors (88%) were excised via translabyrinthine approach while two tumors (13%) were excised via transpetrosal approach. One patient (6.3%) developed a postoperative CSF leak. The patient was noted to have hydrocephalus preoperatively. They developed a pseudomeningocele postoperatively with subsequent incisional leakage and ultimately required ventriculoperitoneal shunting.

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 cerebellopontine angle tumors. BiodesignÒ performs well in preventing cerebrospinal fluid leaks and is an attractive alternative to fascial autografts in skull base reconstruction.