Reconstruction After Posterior Cranial Fossa Surgery—Case Report of Application of a Synthetic Tissue Sealant to Augment Dural Closure

Abstract

Cerebrospinal fluid (CSF) leakage following cranial surgery is a well-described and potentially devastating complication, particularly in posteriorcranial fossa surgery. If untreated, a persistent CSF leak can evolve into wound breakdown, a surgical-site infection, and meningitis. Themorbidity of a complication following a cranial operation is harmful to the patient. Additionally, complications are a source of elevated medicalcosts. Numerous reconstruction strategies have been developed to thwart the ill effects of CSF leaks on patient outcomes and healthcarefinances. This case report illustrates the method employed at our institution to repair posterior fossa defects following surgery in thecerebellopontine angle.

Postoperative CSF Leak: Blood Patch—A New Avenue

“…1 The risk further increases if meningitis sets in thereby also increasing the morbidity. 2,3 The presence of CSF leaks mandates a long intensive care unit stay, antibiotics to prevent infections, lumbar drain, revision surgeries, resuturing, and shunt placement. [9][10][11] Blood patch has been used to treat spontaneous dural rupture that results in intracranial hypotension.…”

“…2 With this complication, the possibility of developing meningitis and that resulting in morbidity always remains. [2][3][4] The costs involved in treating postoperative CSF leak increases exponentially that becomes a barrier in continuing optimum treatment. 2 Since most of these CSF leaks postoperatively are low pressure leaks, the treatment options are to first manage with agents that Introduction Cerebrospinal fluid leak (CSF) after a neurosurgical procedure is a known complication that may result in bad outcomes (1).…”