Paramedian forehead flap for repair of refractory high-flow anterior skull base csf leak
| Autor: | Brandon Lucke-Wold, Paul T. Akins, Haley E. Gillham, David Cua, Jason Kim, Jeremy N. Ciporen |
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| Rok vydání: | 2017 |
| Předmět: |
Leak
medicine.medical_specialty Frontal sinus business.industry medicine.medical_treatment Fistula medicine.disease Surgery 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Pneumocephalus Refractory 030220 oncology & carcinogenesis Forehead medicine Forehead flap Neurology (clinical) business 030217 neurology & neurosurgery Craniotomy Anterior skull base |
| Zdroj: | Turkish Neurosurgery. |
| ISSN: | 1019-5149 |
| DOI: | 10.5137/1019-5149.jtn.20662-17.1 |
| Popis: | Aim The paramedian forehead flap (PMFF) has been well described for nasal reconstruction. However, it has never been reported for use in the repair of high flow anterior skull base cerebral spinal fluid (CSF) leaks. Material and methods The patient is a 55 yo African American male cocaine abuser who initially presented with a high flow anterior skull base CSF leak, extensive pneumocephalus, and intra-cerebral and intra-ventricular abscesses with an oro-nasal-cerebral fistula. The patent initially underwent bi-frontal craniotomy, exenteration of the frontal sinus, abdominal fat graft, resection of intra-cerebral abscesses, and repair of high flow anterior skull base CSF leak with a pedicled pericranial flap (PF). 18 months after the patient's surgery he had resumed his use of cocaine and suffered necrosis of his PF. This caused his high flow CSF leak to recur. After extensive psychiatric treatment, he stopped cocaine use and was subsequently repaired with a pedicled de-epithelialized PMFF originating off the bilateral supratrochlear arteries. Results The patient has had no CSF leak for 3 years, and primary closure of the forehead was achieved with good cosmetic outcome. Conclusion This case highlights the use of PMFF for the treatment of recurrent high flow anterior skull base CSF leak. It also highlights the importance of treatment of the patient's underlying medical disorder, in this case, the patient's addiction to cocaine. We provide a detailed discussion for the use of the de-epithelialized PMFF and how it can be utilized as a vascularized reconstructive technique to repair complex refractory cerebral spinal fluid leaks. |
| Databáze: | OpenAIRE |
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