{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:45:54Z","timestamp":1792176354888,"version":"4.4.0"},"reference-count":18,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,3,25]],"date-time":"2020-03-25T00:00:00Z","timestamp":1585094400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: No dural substitute has proven to be complication-free in a large clinical trial, even suggesting some benefit during watertight closure. However, primary dural closure is not always possible due to dural shrinkage from electrocautery for dural bleeding. Objective: This study is performed to analyze the clinical outcomes related to cerebrospinal fluid (CSF) leakage after microvascular decompression (MVD) using a simple surgical technique. Methods: Three hundred and sixty consecutive cases were treated with MVD and followed up for more than one month after surgery. Bleeding from the cut veins during dural incision was controlled by pulling stay sutures instead of electrocautery to avoid dural shrinkage. Additionally, a wet cottonoid was placed on the cerebellar side dural flap to prevent dural dehydration. During dural closure, primary dural closure was always attempted. If not possible, a \u201cplugging muscle\u201d method was used for watertight dural closure. Results: The mean age was 54.1 \u00b1 10.8 years (range, 24\u201385 years), and 238 (66.1%) were female. Primary MVD was performed in 345 (95.8%) patients. The mean operation time (from skin incision to skin closure) was 96.7 \u00b1 33.0 min (range, 38\u2013301 min). Primary dural closure was possible in 344 (95.6%) patients. The \u201cplugging muscle method\u201d was performed more frequently in patients older than 60 years (8 of 99 cases, 8.08%) than in younger cases (8 of 261 cases, 3.07%) (p = 0.039; chi-squared test). After surgery, 5 (1.4%) patients were treated for middle ear effusion, and another 5 (1.4%) patients experienced transient CSF rhinorrhea, which was spontaneously resolved within 1 to 7 days. No patients required additional treatments for CSF leakage. Conclusion: A simple technique using pulling stay sutures to stop bleeding from the dural edges and placing a wet cottonoid on the exposed dura can make primary dural closure easier.<\/jats:p>","DOI":"10.3390\/jcm9040902","type":"journal-article","created":{"date-parts":[[2020,4,2]],"date-time":"2020-04-02T13:39:34Z","timestamp":1585834774000},"page":"902","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Surgical Nuances to Reduce and Manage Cerebrospinal Fluid Leaks after Microvascular Decompression"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3515-3771","authenticated-orcid":false,"given":"Kyeong-O","family":"Go","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Gyeongsang National University Hospital, Gyengsangnam-do 52727, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7211-729X","authenticated-orcid":false,"given":"Kihwan","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Korea"},{"name":"Department of Neurosurgery, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Ho","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Korea"},{"name":"Department of Neurosurgery, Seoul National University College of Medicine, Seoul 03080, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.4103\/2152-7806.146154","article-title":"Two alternative dural sealing techniques in posterior fossa surgery: (Polylactide-co-glycolide) self-adhesive resorbable membrane versus polyethylene glycol hydrogel","volume":"5","author":"Schiariti","year":"2014","journal-title":"Surg. 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B Skull Base"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.3171\/2015.1.JNS142102","article-title":"Reduced CSF leak in complete calvarial reconstructions of microvascular decompression craniectomies using calcium phosphate cement","volume":"123","author":"Eseonu","year":"2015","journal-title":"J. Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1007\/s00701-014-2190-x","article-title":"Reconstruction after retrosigmoid approaches using autologous fat graft-assisted Medpor Titan cranioplasty: Assessment of postoperative cerebrospinal fluid leaks and headaches in 60 cases","volume":"156","author":"Ling","year":"2014","journal-title":"Acta Neurochir. (Wien)"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.wneu.2016.02.071","article-title":"Calcium Phosphate Cement Cranioplasty Decreases the Rate of Cerebrospinal Fluid Leak and Wound Infection Compared with Titanium Mesh Cranioplasty: Retrospective Study of 672 Patients","volume":"95","author":"Foster","year":"2016","journal-title":"World Neurosurg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/4\/902\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:11:26Z","timestamp":1760173886000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/4\/902"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,25]]},"references-count":18,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,4]]}},"alternative-id":["jcm9040902"],"URL":"https:\/\/doi.org\/10.3390\/jcm9040902","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,25]]}}}