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CC BY 4.0 · Indian Journal of Neurotrauma 2024; 21(02): 180-184
DOI: 10.1055/s-0044-1778734
Case Report

Massive Craniocerebral Wound Reconstruction Using Fascia Lata Graft: A Case Report and Technical Note

Charles Champeaux Depond 
1   Department of Neurosurgery, Clairval Private Hospital, Marseille, France
,
Anne-Laure Bernat
2   Department of Neurosurgery, Larbiboisière Hospital, Paris, France
,
Philippe Metellus
1   Department of Neurosurgery, Clairval Private Hospital, Marseille, France
3   Institut de Neurophysiopathologie – CNRS UMR 7051, Aix-Marseille Université, Marseille, France
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Funding None.
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Abstract

Penetrating head injury is rare and, their management is nonstandard with persistent cerebrospinal fluid (CSF) leakage being possibly challenging to treat. A 34-year-old man with no past medical history was referred in emergency room for an impressive accidental penetrating craniocerebral wound through which the brain was extruding due to the raised intracranial pressure. Computed tomography scan showed a comminuted frontal fracture extended to the anterior skull base and a severe bifrontal lobe concussion with a diffuse intracranial hemorrhage. A debridement and washout of the craniocerebral wound were achieved with careful hemostasis followed by a decompressive craniectomy. Fortunately, the patient survived but, the CSF continued to leak through the anterior skull base fracture with no endoscopic treatment possibility. Fifteen days after the initial trauma, a surgical sealing was decided using a large fascia lata sheath harvested on the right thigh by a “S”-shaped incision. A significant piece of fascia lata was cut off and meticulously sutured to the remaining dura mater rims in double-layered watertight fashion. Both cranial and right thigh wounds healed uneventfully and the CSF leak never reoccurred. Twenty-two weeks after the initial trauma, a custom-made titanium cranioplasty was inserted without any dissection difficulty. In case of persistent CSF leakage not amenable to endonasal endoscopic treatment, the use of a large piece of facia lata harvested on the thigh using an “S”-shaped incision is a simple, reliable way to efficiently repair a large dura mater defect. It requires neither special skills nor sophisticated instruments.

Keywords

traumatic brain injury - penetrating brain injury - CSF leakage - facia lata - reconstruction

Ethical Approval

This case report complies with the guidelines for human studies and was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. Ethical approval was not required for this case report in accordance with the French Scientific Research Ethics Committee policies.




Publikationsverlauf

Artikel online veröffentlicht:
31. Januar 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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