Download PDF
CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(03): 365-368
DOI: 10.1055/s-0042-1748650
Breast/Trunk
Case Report

Gluteus Maximus Muscle Flap in Tongue in Groove and Wrap Around Pattern for Refractory CSF Leakage in Extradural Cyst Patient

Kyong Chan Park
1   Department of Plastic and Reconstructive Surgery and College of Medicine, Soonchunhyang University, Bucheon, Korea
,
Jun Ho Lee
2   Department of Plastic and Reconstructive Surgery and College of Medicine, Soonchunhyang University, Cheonan, Korea
,
Jae Jun Shim
3   Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan, Korea
,
Hyun Ju Lee
4   Department of Pathology, College of Medicine, Soonchunhyang University, Cheonan, Korea
,
Hwan Jun Choi
2   Department of Plastic and Reconstructive Surgery and College of Medicine, Soonchunhyang University, Cheonan, Korea
5   Institute of Tissue Regeneration, Soonchunhyang University, Cheonan, Korea
› Author Affiliations Funding This work was supported by grants from National Research Foundation of Korea (NRF), grants founded by the Korea government (MSIT) (No. 2020R1A2C110089), and was supported by Soonchunhyang University research fund.
› Further Information
   Permissions and Reprints

Abstract

Spinal extradural arachnoid cyst (SEAC) is a rare disease and has surgical challenges because of the critical surrounding anatomy. We describe the rare case of a 58-year-old woman who underwent extradural cyst total excision with dural repair and presented with refractory cerebrospinal fluid (CSF) leakage even though two consecutive surgeries including dural defect re-repair and lumbar-peritoneal shunt were performed. The authors covered the sacral defect using bilateral gluteus maximus muscle flap in tongue in groove and wrap around pattern for protection of visible sacral nerve roots and blockage of CSF leakage point. With the flap coverage, the disappearance of cyst and fluid collection was confirmed in the postoperative radiological finding, and the clinical symptoms were significantly improved. By protecting the sacral nerve roots and covering the base of sacral defect, we can minimize the risk of complication and resolve the refractory fluid collection. Our results suggest that the gluteus muscle flap can be a safe and effective option for sacral defect and CSF leakage in extradural cyst or other conditions.

Keywords

tongue in groove and wrap around pattern - gluteus maximus muscle flap - extradural cyst - cerebrospinal fluid - sacral defect

Ethical Approval

The study was performed in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained.


Patient Consent

The patient provided written informed consent for the publication and the use of his images.


Author Contributions

Conceptualization : H.J.C. Data curation : J.J. S. and J.H.L. Methodology : H.J.L. Project administration : H.J.C. Writing-original draft : K.C.P. Writing-review and editing : K.C.P.




Publication History

Article published online:
27 May 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kelley SP, Ashford RU, Rao AS, Dickson RA. Primary bone tumours of the spine: a 42-year survey from the Leeds Regional Bone Tumour Registry. Eur Spine J 2007; 16 (03) 405-409
    CrossrefPubMedGoogle Scholar
  • 2 Lee CH, Hyun SJ, Kim KJ, Jahng TA, Kim HJ. What is a reasonable surgical procedure for spinal extradural arachnoid cysts: is cyst removal mandatory? Eight consecutive cases and a review of the literature. Acta Neurochir (Wien) 2012; 154 (07) 1219-1227
    CrossrefPubMedGoogle Scholar
  • 3 Woo JB, Son DW, Kang KT. et al. Spinal extradural arachnoid cyst. Korean J Neurotrauma 2016; 12 (02) 185-190
    CrossrefPubMedGoogle Scholar
  • 4 Basaldella L, Orvieto E, Dei Tos AP, Della Barbera M, Valente M, Longatti P. Causes of arachnoid cyst development and expansion. Neurosurg Focus 2007; 22 (02) E4
    CrossrefPubMedGoogle Scholar
  • 5 Samartzis D, Gillis CC, Shih P, O'Toole JE, Fessler RG. Intramedullary spinal cord tumors: part I-epidemiology, pathophysiology, and diagnosis. Global Spine J 2015; 5 (05) 425-435
    CrossrefPubMedGoogle Scholar
  • 6 Choi SW, Seong HY, Roh SW. Spinal extradural arachnoid cyst. J Korean Neurosurg Soc 2013; 54 (04) 355-358
    CrossrefPubMedGoogle Scholar
  • 7 Oh JK, Lee DY, Kim TY. et al. Thoracolumbar extradural arachnoid cysts: a study of 14 consecutive cases. Acta Neurochir (Wien) 2012; 154 (02) 341-348
    CrossrefPubMedGoogle Scholar
  • 8 Kim IS, Hong JT, Son BC, Lee SW. Noncommunicating spinal extradural meningeal cyst in thoracolumbar spine. J Korean Neurosurg Soc 2010; 48 (06) 534-537
    CrossrefPubMedGoogle Scholar
  • 9 Choi JY, Kim SH, Lee WS, Sung KH. Spinal extradural arachnoid cyst. Acta Neurochir (Wien) 2006; 148 (05) 579-585
    CrossrefPubMedGoogle Scholar
  • 10 Netra R, Min L, Shao Hui M, Wang JC, Bin Y, Ming Z. Spinal extradural meningeal cysts: an MRI evaluation of a case series and literature review. J Spinal Disord Tech 2011; 24 (02) 132-136
    CrossrefPubMedGoogle Scholar
  • 11 Ishibe T, Senzoku F, Ikeda N, Kamba Y, Mikawa Y. Detection of the communicating hole(s) of spinal extradural arachnoid cysts using time-spatial labeling inversion pulse magnetic resonance imaging. Spine 2014; 39 (23) E1394-E1397
    CrossrefPubMedGoogle Scholar
  • 12 Bae SW, Lim TK, Kim HS, Song BY. Hatchet-type gluteus maximus musculocutaneous flap for reconstruction of sacral pressure sore. Arch Hand Microsurg 2014; 23 (01) 25-28
    CrossrefGoogle Scholar
  • 13 Wanjala NF, Stanley KO. Island latissimus dorsi muscle flap and a perforator flap in repairing post-gunshot thoracic spine CSF fistula: case presentation. Case Rep Surg 2015; 2015: 219535
    PubMedGoogle Scholar
  • 14 Banerjee C, Cross B, Rumley J, Devine J, Ritter E, Vender J. Multiple-layer lumbosacral pseudomeningocele repair with bilateral paraspinous muscle flaps and literature review. World Neurosurg 2020; 144: e693-e700
    CrossrefPubMedGoogle Scholar
  • 15 Singh S, Bhaisora KS, Sardhara J. et al. Symptomatic extradural spinal arachnoid cyst: more than a simple herniated sac. J Craniovertebr Junction Spine 2019; 10 (01) 64-71
    CrossrefPubMedGoogle Scholar