Experience with osteoplastic posterior fossa craniotomy in 13 children

Background: Posterior fossa free bone flap craniotomy in children is being currently used, and it significantly decreases postoperative cerebrospinal fluid (CSF) leakage and pseudomeningoceles. However, sometimes bone displacement, bone resorption, osteonecrosis, or infection occurs in a few children after posterior fossa free bone flap craniotomy. So, in recent years, a few posterior fossa osteoplastic craniotomy techniques to overcome these complications have been described. Here, we are documenting our experiences with one of the previously described techniques of osteoplastic craniotomy, with some modification in cases of pediatric posterior fossa tumor. We called this described procedure "ligamentous osteoplastic midline posterior fossa craniotomy (LOM-PFC)," as it preserves the attachments of the posterior atlanto-occipital membrane. Materials and Methods: This LOM-PFC approach was implemented between 2018 and 2019 in 13 pediatric patients who were suffering from posterior fossa tumor. Perioperative and follow-up clinico-radiologic details were reviewed. Results: Only one patient had transient mild CSF accumulation, which was managed by lumbar punctures. A 3D reconstruction of computed tomography (CT) scan head verified a well-aligned and fused LOM-PFC flap during the postoperative and the follow-up period, respectively. Cosmetic results were excellent. The maximal follow-up period was one year. Conclusions: We found that the LOM-PFC approach had no added risk. It preserves the anatomy of the foramen magnum and allows more stable fixation of the bone flap, which minimizes the risk of CSF leakage, pseudomeningocele and finally reduces the hospital stay. This approach is easy to learn, feasible, and cosmetically effective.