Brain stem compression secondary to adipose graft prolapse after transpetrosal approach: Case report

Fat Graft Displacement after Retroauricular Surgery of a Petrous Meningioma

“…It has been regularly used in vestibular schwannoma surgery especially after opening mastoid cells [2] or transsphenoidal surgery [3] and has now become an approved method for preventing or repairing CSF leaks. Cerebral fat dislocation has been described only very few times [4,5] and the displaced fat graft could even lead to brainstem compression [4,5]. In the present case it could be shown that a fat graft can migrate long distances into the brain and reach the anterior basal cisterns.…”

“…In the literature Chen et al [5] as well as Spallone and Rizzo [4] described a fat graft dislocation and even brain stem compression. Both groups decided to perform a surgical revision.…”

“…All symptoms occurred 1 day after the operation, all were diagnosed via CCT scan and all three patients underwent surgical revision. Spallone and Rizzo [4] described one patient who underwent transpetrosal surgery for a large craniopharyngioma. The patient became stuporous, aphasic and had a right hemiparesis on day 6 after the operation.…”

Intracranial fat migration: A newly described complication of autologous fat repair of a cerebrospinal fluid leak following supracerebellar infratentorial approach

“…Autologous fat graft migration has been described following retroauricular craniotomy, with some cases leading to brain stem compression [13–16] . Additionally, adipose migration has been described following lumbar surgery leading to complications of cauda equina syndrome, recurrent sciatica, and root compression [17–22] .…”

Late midbrain compression by liquefied fat in a case operated for an acoustic neuroma

“…A search of the literature revealed three articles due to fat-related brain stem compresion. [1][2][3] In one case in which autologous thigh fat strips to obliterate the mastoid cavity were used, postoperatively the patient suffered a serious deterioration from adipose graft prolapse into the prepontine cistern. 3 In another article with two cases, transposition of fat resulted in one of two cases with mortality.…”