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Published on: February 29, 2020
Multidisciplinary Approach to Managing Recurrent Cerebrospinal Fluid Leak in a Pediatric Patient Following
Rawad Chalhoub1, Kareem Makkawi1, Edwin Chrabieh1
1From the Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Insights
This case report details managing a pediatric cerebrospinal fluid (CSF) leak after myelomeningocele repair. A multidisciplinary approach using Integra, VAC therapy, and a shunt successfully closed the complex wound and resolved the leak.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Wound Healing
Background:
- Cerebrospinal fluid (CSF) leaks pose significant challenges, particularly in pediatric patients with a history of myelomeningocele repair.
- Recurrent CSF leaks, wound dehiscence, and infection complicate management, necessitating advanced therapeutic strategies.
Observation:
- A 6-year-old girl with a post-traumatic CSF leak following myelomeningocele repair presented with recurrent leakage, wound breakdown, and infection.
- Initial surgical attempts, including a latissimus dorsi flap, failed to resolve the persistent CSF leak and associated complications.
Findings:
- A secondary dural defect repair combined with lumbar drainage, Integra dermal regeneration template, and vacuum-assisted closure (VAC) therapy was employed.
- Subsequent insertion of a ventriculoperitoneal shunt facilitated optimal lumbar drainage.
- The patient experienced complete wound closure and resolution of CSF leakage without further complications.
Implications:
- This case highlights the efficacy of a multidisciplinary strategy in managing complex pediatric CSF leaks.
- The combination of Integra, VAC therapy, and CSF diversion (lumbar drain/shunt) offers a viable solution for challenging wound healing scenarios.
- Successful management underscores the importance of tailored, integrated approaches for pediatric neurosurgical complications.
Abstract:
This case report describes the management of a 6-year-old girl with a cerebrospinal fluid (CSF) leak following trauma after a previous myelomeningocele repair. The patient initially presented with a recurrent CSF leak, wound dehiscence, and infection. In an attempt to close the pseudomeningocele, a bilateral latissimus dorsi musculocutaneous flap procedure was performed. Despite this intervention, she developed a persistent CSF leak, which led to infection and dehiscence of the wound at the midline. She then required secondary repair of the dural defect and insertion of a lumbar drain, while the plastic surgery team applied an Integra dermal regeneration template combined with vacuum-assisted closure (VAC) therapy. One week later, the wound showed no signs of infection, and the VAC was removed. One week later, for optimal lumbar drainage, a ventriculoperitoneal shunt was inserted. The patient's postoperative course was complicated by fever and ileus, both of which resolved with bowel rest and antibiotics. The patient was discharged in stable condition with no further leakage. On follow-up 4 months later, the patient reported no issues. This case illustrated the successful use of a multidisciplinary approach in managing CSF leaks following myelomeningocele repair by using Integra combined with VAC therapy and a ventriculoperitoneal shunt for optimal wound closure and healing.
