Download PDF
CC BY 4.0 · Indian Journal of Neurotrauma
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
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

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. Informed consent for publication of this case report and any accompanied images was obtained from the patient.




Publication History

Article published online:
31 January 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/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Dewan MC, Rattani A, Gupta S. et al. Estimating the global incidence of traumatic brain injury. J Neurosurg 2018; 130 (04) 1080-1097
    Google Scholar
  • 2 Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2 (7872): 81-84
    Google Scholar
  • 3 Iaccarino C, Carretta A, Nicolosi F, Morselli C. Epidemiology of severe traumatic brain injury. J Neurosurg Sci 2018; 62 (05) 535-541
    Google Scholar
  • 4 D'Agostino R, Kursinskis A, Parikh P, Letarte P, Harmon L, Semon G. Management of penetrating traumatic brain injury: operative versus non-operative intervention. J Surg Res 2021; 257: 101-106
    Google Scholar
  • 5 Vakil MT, Singh AK. A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment. Emerg Radiol 2017; 24 (03) 301-309
    Google Scholar
  • 6 Zyck S, Toshkezi G, Krishnamurthy S. et al. Treatment of penetrating nonmissile traumatic brain injury. Case series and review of the literature. World Neurosurg 2016; 91: 297-307
    Google Scholar
  • 7 Champeaux-Depond C, Passeri T, Caudron Y. When a transorbital penetrating brain injury reveals the infratentorial tumor: a case report and technical note. Indian J Neurotrauma 2023; DOI: 10.1055/s-0043-1769801.
    Google Scholar
  • 8 Esposito DP, Walker JB. Contemporary management of penetrating brain injury. Neurosurg Q 2009; 19 (04) 249-254
    Google Scholar
  • 9 Yoneoka Y, Aizawa N, Nonomura Y, Ogi M, Seki Y, Akiyama K. Traumatic nonmissile penetrating transnasal anterior skull base fracture and brain injury with cerebrospinal fluid leak: intraoperative leak detection and an effective reconstruction procedure for a localized skull base defect especially after coronavirus disease 2019 outbreak. World Neurosurg 2020; 140: 166-172
    Google Scholar
  • 10 Yuan YK, Sun T, Zhou YC, Li XP, Yu H, Guan JW. Rational design of secondary operation for penetrating head injury: a case report. Chin J Traumatol 2020; 23 (02) 84-88
    Google Scholar
  • 11 Amir A, Gur E, Gatot A, Zucker G, Cohen JT, Fliss DM. Fascia lata sheaths harvest revisited. Oper Tech Otolaryngol–Head Neck Surg 2000; 11 (04) 304-306
    Google Scholar
  • 12 Amir A, Gatot A, Zucker G, Sagi A, Fliss DM. Harvesting large fascia lata sheaths: a rational approach. Skull Base Surg 2000; 10 (01) 29-34
    Google Scholar