J Korean Neurosurg Soc.  2013 May;53(5):300-302. 10.3340/jkns.2013.53.5.300.

Treatment of a Traumatic Leptomeningeal Cyst in an Adult with Fibrinogen-Based Collagen

• Kim H
• Jo KW

• KMID: 1426199
• DOI: http://doi.org/10.3340/jkns.2013.53.5.300

Abstract

Reports of traumatic leptomeningeal cysts (TLMC) are rare in adults. The standard treatment approach is craniectomy with careful exposure of the intact dural edges, followed by duroplasty. However, occasionally, the location of the TLMC makes achieving watertight duroplasty impossible. Herein, we report the case of a 28-year-old male who presented with a soft growing mass on the vertex of his head 16 months after the head trauma. Upon enhanced CT examination, a bony defect involving both the inner and outer table of the cranium was observed close to the sagittal sinus, and a well-defined cystic mass, 5 cm in diameter, was nested within the defect. The risks associated with extension craniotomy were high because the lesion was located superficial to the sagittal sinus, we opted to use fibrinogen-based collagen fleece (TachoCombR(R)) to repair the dural defect. Two months after surgery, the patient remained asymptomatic with a good cosmetic result. In cases like ours, when the defect is near the major sinuses and the risk of rupturing the sinus during watertight dural closure is high, fibrinogen-based collagen fleece (TachoComb(R)) is an effective alternative approach to standard dural suture techniques.

Keyword

Adult; Leptomenigeal cyst; Skull fracture

MeSH Terms

Adult
Arachnoid Cysts
Collagen
Cosmetics
Craniocerebral Trauma
Craniotomy
Head
Humans
Male
Skull
Skull Fractures
Suture Techniques
Collagen
Cosmetics

Figure

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  Fig. 1 Enhanced computed tomography showing a cystic lesion proximal to the sagittal sinus without an intracranial lesion.

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  Fig. 2 Intraoperative photograph showing a round, 5 cm in diameter, bone defect covered by the cyst wall (A). Intraoperative photograph showing TachoComb® placed onto the area of dural defect, exceeding the margins by about 0.5 cm (B).

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  Fig. 3 Histologic findings include lining by meningothelial cells resting on a layer of supporting fibrous tissue, vascular congestion, and mild chronic inflammatory cell infiltration in the cyst wall. Low power microscopy reveals thick fibrous cystic walls (H&E, 40× magnification) (A). The cyst was lined by flattened epithelial cells (H&E, 400× magnification) (B).

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  Fig. 4 Follow up CT revealed no recurrent cystic mass and good cosmetic result.

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