Rotational Pericranial Flap for Repair of Refractory Posterior Fossa Pseudomeningocele

Rajiv Saigal,Steven W Cheung,Arnau Benet,Michael Mcdermott,Lawrence R Lustig,William Hoffman

doi:10.7759/cureus.153

Abstract

Skull base approaches requiring retro- or translabyrinthine petrosectomy are frequently used for vestibular schwannoma and cerebellopontine angle tumor removal. One postoperative challenge is pseudomeningocele formation. Primary dural closure is often impractical due to dural shrinkage from cautery [1], desiccation, and the fact that pre-sigmoid dura is difficult to approximate with the retro/translabyrinthine approach. Synthetic, allograft, and autograft dural substitutes have been used with varying success rates. Pericranial autograft is a desirable substitute due to lack of immunogenicity, flexibility, and wide availability adjacent to posterior fossa lesions. Autologous fat has been used to pack the pre-sigmoid dural defect in order to effect a watertight seal. However, no method is completely effective.

Highlights

Repairing a pseudomeningocele after a skull base approach in association with retro- or translabyrinthine petrosectomy remains a challenging clinical problem
We present a technical note on use of a vascularized rotational pericranial flap technique for repair of refractory pseudomeningocele after translabyrinthine petrosectomy
We utilize the principles of plastic and reconstructive surgery in the implementation of a rotational pericranial flap for closure of a complex posterior fossa wound

Summary

Introduction

Repairing a pseudomeningocele after a skull base approach in association with retro- or translabyrinthine petrosectomy remains a challenging clinical problem. Plastic and reconstructive surgeons have successfully used vascularized pericranial flaps for reconstruction of congenital cranial malformations [1718], repair of chronic scalp ulcers [19], dura mater reconstruction after decompressive craniectomy complicated by infection [20], orbital [21,22] and nasal septum [23] reconstruction, repair of supratarsal sulcus depression [24], cranial base reconstruction after tumor resection [25], and frontal sinus fracture repair [26] In this technical note, we utilize the principles of plastic and reconstructive surgery in the implementation of a rotational pericranial flap for closure of a complex posterior fossa wound

Methods

Results

Discussion

Conclusion