title: The temporoparietal fascia flap folded into a ball in the treatment of retroauricular cerebrospinal fluid fistulae after posterior fossa surgery.
abstract: Skull base and posterior fossa surgeries are sometimes complicated by cerebrospinal fluid (CSF) fistulae, which may be challenging to treat. They can lead to meningitis, increasing global morbidity and mortality. In case of failed medical treatment, revision surgery may be required. "Fat packing" (adipose tissue grafts) is usually used to close the communication between the intracranial contents and the cutaneous tissue, and to fill the dead space created by the skull base surgery. Vascularised flaps can also be used. They seem more efficient, especially in multi-operated patients or after radiotherapy, when cutaneous tissue is adhesive and fragile.
  
  
  
  Temporoparietal fascia (TPF) flap is a regional flap; it has reliable blood supply and can cover temporal and retroauricular defects. Folded into a ball, it can fill small dead spaces and can be skin grafted in case of cutaneous defect.
  
  
  
  We present a simple surgical solution to manage recurrent retroauricular CSF fistulae after posterior fossa surgery using a pedicled TPF flap folded into a ball.
authors.affiliation: Department of Plastic surgery, AP-HM Hôpital Nord Chemin des bourrely, Marseille, 13915, France. charlotte.jaloux@ap-hm.fr.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Jaloux
authors.affiliation: Department of Neurosurgery, AP-HM Hôpital Nord Chemin des bourrely, Marseille, 13915, France.
authors.forename: Pierre-Hugues
authors.initials: PH
authors.lastname: Roche
authors.affiliation: Department of Plastic surgery, AP-HM Hôpital Nord Chemin des bourrely, Marseille, 13915, France.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Bertrand
authors.affiliation: Department of Plastic surgery, AP-HM Hôpital Nord Chemin des bourrely, Marseille, 13915, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Casanova
authors.affiliation: Department of Plastic surgery, AP-HM Hôpital Nord Chemin des bourrely, Marseille, 13915, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Philandrianos
mesh_terms: D000328:Adult; D065634:Cerebrospinal Fluid Leak / Q000209:etiology / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D000071938:Fasciotomy / Q000379:methods*; D005260:Female; D005402:Fistula / Q000601:surgery*; D006801:Humans; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D019291:Skull Base / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply*
keywords: Cerebrospinal fluid fistula; Skull base surgery; Temporoparietal fascia flap; Treatment