[Successful reconstruction of a skull base fracture with frontal lobe contusion by omental transplantation for recurrent posttraumatic tension pneumocephalus: a case report].

In July 1983, 26 year-old male was admitted to our neurosurgical clinic after severe head injury caused by a car accident. Recovery of consciousness was delayed for months due to bilateral frontal lobe contusions with anterior skull base fractures on both sides. He was first discharged 6 months after surgery for ventriculo-peritoneal shunting. He was readmitted to our department due to an episode of urinary incontinence with gait disturbance 11 months after the accident. CT film of the head revealed the presence of an air shadow at the left frontal base. Utilizing lyophyllized dura mater, the first cranial surgery for closure of cerebrospinal fluid leakage was carried out in July, 1984. Pneumocephalus with meningitis recurred again five years later. Repeated conventional surgery failed including a transsphenoidal and transfrontal sinus approach to treat the recurrent pneumocephalus. In order to close the defect in the skull base, and to obliterate the dead space in the left frontal lobe, vital tissue transplantation was planned. On May 23, 1990, seven years after the accident, the skull base defect was repaired by suturing fascia taken from the temporal muscle. Then the patient's vascularized omentum was utilized as an autograft by micro-surgical technique. A superficial temporal artery and vein, and superficial sylvian vein were used to vascularize the omentum. The patient has been totally free of pneumocephalus for more than three and half years following the radical surgery. Clinical omental transplantation using microsurgical technique for vascularization of cerebral circulation as well as plastic surgery has been reported.(ABSTRACT TRUNCATED AT 250 WORDS)