Revision Surgery Technique in the Treatment of Refractory Subcutaneous Cerebrospinal Fluid Collection Combined with Intracranial Infection Following Posterior Fossa Surgery.

Weilong Ding,Jason H Huang,Jiancheng Liao,Hua Chen,Xiaoming Qi,Yongsheng Xiang,Xiangyu Wang

doi:10.7759/cureus.10610

Abstract

ObjectiveCerebrospinal fluid (CSF) leakage remains the most common and serious complication following posterior fossa surgery. Persistent subcutaneous CSF collections can cause wound dehiscence and predispose patients to intracranial infection. Management with conservative treatment fails in up to 40% of patients, and revision surgery remains the last resort. We hereby introduce a novel surgical technique using muscle graft or pedicled trapezius muscle flaps to repair dura and skull base defect for the treatment of subcutaneous CSF collections refractory to conservative management.MethodsA retrospective chart review was conducted for six patients who presented to our institution from 2012 to 2020, with subcutaneous CSF collections following posterior fossa surgeries and had undergone revision surgeries after unsuccessful management with conservative treatments. Patient demographics, etiologies, culture results, revision procedures, follow-ups, and recurrences of fluid collections were collected.ResultsOf these six patients, two underwent repair of dura and skull base defect with pedicled trapezius muscle flaps, and four had arachnoid fistula repaired with autologous muscle graft. All six patients fully recovered. CSF leakage and subcutaneous fluid collections were resolved. No recurrences occurred upon the last follow-ups.ConclusionA revision surgery using muscle graft or pedicled trapezius muscle flaps to repair the dura and skull base defect is effective at treating persistent cerebrospinal fluid leakage and subcutaneous fluid collection refractory to conservative treatment.

Highlights

Cerebrospinal fluid (CSF) leakage remains a serious complication that most commonly occurs following posterior fossa surgery and presents as subcutaneous CSF fluid collection [1,2,3]
A retrospective chart review was conducted for six patients who presented to our institution from 2012 to 2020, with subcutaneous CSF collections following posterior fossa surgeries and had undergone revision surgeries after unsuccessful management with conservative treatments
A retrospective chart review was conducted for six patients who underwent revision surgeries for subcutaneous CSF collections complicated with intracranial infection after posterior fossa surgeries from March 2012 to February 2020 at our institution

Summary

Introduction

Cerebrospinal fluid (CSF) leakage remains a serious complication that most commonly occurs following posterior fossa surgery and presents as subcutaneous CSF fluid collection (aka pseudomeningocele) [1,2,3]. When conservative treatments fail as initial management, aspiration of the subcutaneous fluid collection, continuous lumbar drainage or lumboperitoneal CSF shunts can be employed [5]. Revision surgery remains the last resort if all other measures fail, which is the treatment of choice for patients with intracranial infection. Management of this difficult-to-treat complication has been documented in the literature [5,6,7]. We hereby describe a unique surgical technique repairing CSF leakage with pedicled muscle flap covering the extensive defect in the posterior fossa

Methods

Discussion

Conclusion