A 29-year-old woman diagnosed with Arnold Chiari malformations had an occipitocervical decompression surgery, due to progressive headache, in 2013. Two years later, a second decompression surgery was done due to progressive ataxia and paraesthesia in her right arm. During the surgery, a titanium plate was attached to the remains of C1, and a synthetic dural substitute was inserted. Postoperatively two MRI scans within a month revealed accumulation of CSF superficial to the dural repair site. A dural repair with a synthetic mesh was repeated twice. When the patient for the third time leaked CSF from the wound, the leakage was sealed with porcine ADM (StratticeTM pliable).
A suitable piece of StratticeTM pliable was placed over the leak site and sutured, see Figure 1. Before closing, the ADM was covered with TachoSil  and TissellTM. After insertion, no CSF leakage was observed. However, the inserted ADM pulsated. The soft tissue was closed in layers. No drains were inserted.
Eight months postoperatively, the patient had not experienced further setbacks. The healing process is ongoing.