A Simple Strategy for Treating Persistent Subcutaneous Cerebrospinal Fluid (CSF) Collections Following Complex...

Subcutaneous CSF (CSF "pseudocyst") may occur following complex skull base operations. They may respond to a trial of compressive bandages and continuous lumbar drainage that can resolve over months. When this management strategy fails, reoperation is an option, which however would require complex reconstructive procedures at the base of the skull, and still have the chance of not resolving the problem.We describe here a simple alternative treatment, consisting of a "pseudocyst"-peritoneal shunting using a flow-regulated unishunt system. This management strategy has been used successfully in two cases showing subcutaneous CSF collections following complex skull base surgery procedures which did not respond to a trial of conservative management. A prompt resolution of such a complication was achieved in all cases, which persisted during the follow-up (7 to 19 months, averaging 12 months). "Pseudocyst"-peritoneal shunting using a flow-regulated valve can be a very simple though effective management option for persistent CSF subcutaneous collections following major neuro-surgical procedures.