Complex reconstructive surgery following removal of extra-intracranial meningiomas, including the use of autologous fibrin glue and a pedicled muscle flap

• Clinical case of a very large biparietal extra-intracranial high grade meningioma
• Obtain radical treatment and appropriate reconstruction of the anatomical planes
• Prevent and cure complications as CSF fistulas
• First time to describe the use of autologous fibrin glue in a neurosurgical procedure
• Intra and interdisciplinary collaboration between plastic surgeons and neurosurgeons

BackgroundSkull reconstructive surgery is critical to prevent cerebrospinal fluid (CSF) fistulas and infections, and to ensure good aesthetic results in meningiomas surgery.MethodsA 65-year-old woman was surgically treated for a bilateral parasagittal meningioma with complete superior sagittal sinus (SSS) involvement, and an intra-extracranial extension, determining a significant cranial defect at the vertex. A Simpson I resection was achieved. Postoperatively a considerable and not conservatively repairable CSF leak was detected. Surgical revision of the wound with repair of the fistula and complex reconstructive operation was performed including a combination of techniques and devices such as autologous fibrin glue and reparation of the extracranial planes by an autologous vascularized vastus lateralis pedicled muscle flap.ResultsNo postoperative complications, infections or new neurological deficits were detected, and the CSF leak definitively ceased after surgery; the aesthetic results were satisfactory.ConclusionsReparation of CSF fistulas that arise after meningioma surgery can require a complex reconstructive surgery of the superficial layers; when cranioplasty is not feasible or indicated, a meticulous reconstruction of the extracranial soft tissues is possible also by using vascularized autologous distal muscular tissue, with close interdisciplinary cooperation.