PMC9526421_01
Case 1 (A) Preoperative photograph showing a large scalp defect, with a piece of bovine pericardium graft and cortex exposed. (B) Preoperative CT image showing cerebrum mildly bulge outward the bone window. (C) Photograph showing a linear incision on the anterolateral thigh to harvest free fascia lata. (D) A large piece of free fascia lata was harvested, preparing for dura repair. (E) Intraoperative photograph showing a lot of pus on the surface of cortex when the alien dura was removed. (F) Intraoperative photograph showing dural defect was completely repaired in tension-reduced fashion. (G) The incision was closed after extensive subgaleal dissection. (H) The incision healed uneventfully 1 month after the debridement surgery..
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The process of management is illustrated in Figure 1.
PMC9526421_02
Case 2 (A) Preoperative photograph showing the broken incision with purulent discharge and CSF leakage. (B) Preoperative photograph showing purulent fluid aspired from the subgaleal cystic fluid collection by diagnostic puncture with a fine syringe. (C) Preoperative axial MR image showing high signal in cystic fluid collections beneath the scalp, temporal lobe and in the bilateral occipital horn of enlarged bilateral ventricle in DWI sequence. (D) Coronal T1-weighted postcontrast MR image showing multiple cystic lesions with ring-enhancement. The supratentorial ventricles enlarged significantly with linear ependymal enhancement. (E) Intraoperative photograph showing a lot of pus in communication through a piece of Tissudura sheet. (F) Intraoperative photograph showing dural defect was deliberately repaired with fascial lata.
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Major clinical presentations and management are shown in Figure 2.