Abstract
Background
Skull base and posterior fossa surgeries are sometimes complicated by cerebrospinal fluid (CSF) fistulae, which may be challenging to treat. They can lead to meningitis, increasing global morbidity and mortality. In case of failed medical treatment, revision surgery may be required. “Fat packing” (adipose tissue grafts) is usually used to close the communication between the intracranial contents and the cutaneous tissue, and to fill the dead space created by the skull base surgery. Vascularised flaps can also be used. They seem more efficient, especially in multi-operated patients or after radiotherapy, when cutaneous tissue is adhesive and fragile.
Methods
Temporoparietal fascia (TPF) flap is a regional flap; it has reliable blood supply and can cover temporal and retroauricular defects. Folded into a ball, it can fill small dead spaces and can be skin grafted in case of cutaneous defect.
Results and Conclusions
We present a simple surgical solution to manage recurrent retroauricular CSF fistulae after posterior fossa surgery using a pedicled TPF flap folded into a ball.
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Pierre-Hugues Roche is the associate editor of the section, “How I do it”, in Acta Neurochirurgica.
The other authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
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Jaloux, C., Roche, PH., Bertrand, B. et al. The temporoparietal fascia flap folded into a ball in the treatment of retroauricular cerebrospinal fluid fistulae after posterior fossa surgery. Acta Neurochir 158, 1221–1224 (2016). https://doi.org/10.1007/s00701-016-2775-7
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DOI: https://doi.org/10.1007/s00701-016-2775-7