Unique Far-Lateral Closure Technique: Technical Note COMMENT

BACKGROUND: The far-lateral approach is amainstay in gaining access to the ventrolateral craniocervical junction for tumor removal and the treatment of vascular lesions. It has a reportedly high rate of cerebrospinal fluid leak (up to 20%), which can bring devastating consequences, including meningitis, and may require wound revision associated with a longer hospital stay. OBJECTIVE: To describe a closure technique employed to close the access corridor provided by the far-lateral approach and present an illustrative case. METHODS: The far-lateral closure technique employs dural closure, followed by fat buttress, to alleviate dead space and reduce the likelihood of fluid collection and leakage. RESULTS: This technique has been successfully used by the senior author for more than 14 yr, with a rate of cerebrospinal fluid leak of 2.9%. CONCLUSION: This unique approach and closure of the far-lateral craniotomy is a reasonable option for the approach to the ventrolateral craniocervical junction. Skull base surgeons can consider the use of this closure technique to ensure watertight closure.