The Vascularized Occipital Fascial Flap (OFF): A Novel Reconstructive Technique for Posterior Fossa Surgery

Abstract

Background: Posterior fossa surgery is particularly prone to cerebrospinal fluid (CSF) leakage. Several methods have been introduced to address and/or prevent this complication. However, to the best of our knowledge, the use of a vascularized fascial flap based on the occipital artery for the purpose of reconstruction has not been reported. We introduce the occipital fascial flap (OFF) for reconstruction of a craniectomy defect after the retrosigmoid approach.

Methods: A 57-year-old woman with a large cerebellar metastasis underwent gross total resection of the mass followed by reconstruction of the craniectomy defect using OFF.

Results: Postoperative imaging showed flap viability and no CSF leak occurred during follow-up.

Conclusions: We report the first use of OFF for reconstruction of a craniectomy defect in a retrosigmoid approach. The vascularized fascial flap in posterior fossa surgery is a potentially helpful technique to reduce the risk of CSF leak in high-risk patients.

Keywords: Cerebrospinal fluid leak; Galeofascial flap; Occipital artery; Retrosigmoid.