Ding Weilong, Chen Hua, Xiang Yongsheng, Liao Jiancheng, Qi Xiaoming, Wang Xiangyu, Huang Jason H
Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, CHN.
Neurosurgery, Zhongshan Torch Development Zone Hospital, Zhongshan, CHN.
Cureus. 2020 Sep 23;12(9):e10610. doi: 10.7759/cureus.10610.
Objective Cerebrospinal 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. Methods 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. Patient demographics, etiologies, culture results, revision procedures, follow-ups, and recurrences of fluid collections were collected. Results Of 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. Conclusion A 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.
目的 脑脊液漏仍然是后颅窝手术后最常见且严重的并发症。持续性皮下脑脊液聚集可导致伤口裂开,并使患者易发生颅内感染。保守治疗在高达40%的患者中失败,翻修手术仍是最后的手段。我们在此介绍一种新颖的手术技术,即使用肌肉移植或带蒂斜方肌瓣修复硬脑膜和颅底缺损,以治疗对保守治疗无效的皮下脑脊液聚集。方法 对2012年至2020年在我院就诊的6例患者进行回顾性病历审查,这些患者在后颅窝手术后出现皮下脑脊液聚集,且在保守治疗失败后接受了翻修手术。收集患者的人口统计学资料、病因、培养结果、翻修手术过程、随访情况以及积液复发情况。结果 这6例患者中,2例行带蒂斜方肌瓣修复硬脑膜和颅底缺损,4例行自体肌肉移植修复蛛网膜瘘。所有6例患者均完全康复。脑脊液漏和皮下积液均得到解决。末次随访时无复发。结论 使用肌肉移植或带蒂斜方肌瓣修复硬脑膜和颅底缺损的翻修手术,对于治疗持续性脑脊液漏和对保守治疗无效的皮下积液有效。