Collagen matrix duraplasty for posterior fossa surgery: evaluation of surgical technique in 52 adult patients

2009 ◽  
Vol 111 (2) ◽  
pp. 380-386 ◽  
Author(s):  
Pradeep K. Narotam ◽  
Fan Qiao ◽  
Narendra Nathoo
Keyword(s):  
Posterior Fossa ◽  
Collagen Matrix ◽  
Adult Patients ◽  
Effective Control ◽  
Posterior Fossa Surgery ◽  
Dural Defect ◽  
Wound Drainage ◽  
Closed Suction ◽  
Dural Closure ◽  
Dural Graft

Object Complete dural closure is not always possible following posterior fossa surgery, often requiring a graft to secure complete closure. The authors report their experience of using a collagen matrix as an onlay dural graft for repair of a posterior fossa dural defect. Methods A retrospective analysis was performed in 52 adult patients who had undergone collagen matrix duraplasty for the posterior fossa. Complications directly related to the dural graft, the presence or absence of hydrocephalus, and the role of closed suction wound drainage in relation to postsurgical pseudomeningoceles were analyzed. Results The indication for posterior fossa surgery was tumors in 32 patients, vascular abnormalities in 9 patients, and spontaneous cerebellar hemorrhage in 11 patients. Closed suction wound drainage was used in 23 patients (44.2%). Forty-eight (92.3%) of 52 patients had a dural defect > 2 cm. Nine (81.8%) of 11 patients with hydrocephalus required ventriculoperitoneal shunts. Complications of the surgery included pseudomeningoceles in 2 patients (3.8%; no closed suction wound drainage); superficial wound infections in 1 patient (1.9%; with closed suction wound drainage); and unexplained eosinophilia in 1 patient. Conclusions Duraplasty using a collagen matrix is safe and effective in the posterior fossa, and is easy to use and time efficient. Meticulous layered wound closure, the detection and effective control of hydrocephalus, and the use of closed suction wound drainage reduces complications related to collagen matrix duraplasty for the posterior fossa.

scholarly journals A Comparative Study between Autologous Dural Closure versus Collagen Matrix (DuraGen) Closure in Decompressive Craniectomy for Trauma

2020 ◽  
Vol 17 (01) ◽  
pp. 46-49
Author(s):  
Rajesh Kumar Barooah ◽  
Basanta Kumar Baishya ◽  
Hriday Haloi ◽  
Mrinal Bhuyan ◽  
Asman Ali ◽  
...  
Keyword(s):  
Wound Infection ◽  
Decompressive Craniectomy ◽  
Operating Time ◽  
Collagen Matrix ◽  
Dural Defect ◽  
Temporalis Fascia ◽  
Dural Closure ◽  
Fascia Graft ◽  
Dural Graft ◽  
Csf Leakage

Abstract Introduction Neurosurgeons often deal with the problem of a complete and watertight dural closure after cerebral operative procedures. In decompressive craniectomy done for trauma, autologous grafts such as galea, temporalis fascia can be time consuming. Hence this study was undertaken to look into the outcome using collagen matrix graft for dural closure. Aims and Objectives To study the difference between autologous dural graft closure and collagen matrix graft with respect to the time taken for closure, cerebrospinal fluid (CSF) leakage, and wound infection. Methods This prospective study includes 30 patients who underwent decompressive craniectomy for trauma. Duraplasty with temporalis fascia graft and nonautologous collagen matrix dural patch was done by randomization. Specific time points during craniectomy and cranioplasty was calculated. Total time for the procedures and the time for dural repair and separation was calculated. Results The use of collagen matrix in decompressive craniectomy resulted in decrease in mean operative time during the first surgery by average 45 minutes (p< 0.5) as compared to the use of autologous graft. There is reduction in the operating time during second surgery (cranioplasty) by 35 minutes (p< 0.5). The patients using collagen matrix graft did not record any CSF leakage or wound infection. Excellent uptake of the collagen by the duramater was seen. Conclusion The use of collagen to cover the dural defect for decompressive craniectomy for trauma results in significant reduction in the operating time during the first surgery and also in cranioplasty. There is reduction in CSF leakage and hence duration of hospital stay and cost.

Use of ligamentum nuchae graft for dural closure in posterior fossa surgery

1998 ◽  
Vol 89 (1) ◽  
pp. 155-156 ◽  
Author(s):  
Edward J. Kosnik
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Cerebrospinal Fluid Leakage ◽  
Posterior Fossa Surgery ◽  
Content Type ◽  
Fluid Leakage ◽  
Dural Closure ◽  
Fine Print

✓ The technique of harvesting the ligamentum nuchae and its use in posterior fossa surgery are discussed. By using this technique the author has avoided postoperative cerebrospinal fluid leakage in more than 200 procedures.

Polyethylene Glycol Hydrogel Dural Sealant May Reduce Incisional Cerebrospinal Fluid Leak after Posterior Fossa Surgery

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS182-ONS187 ◽  
Author(s):  
Khoi D. Than ◽  
Clinton J. Baird ◽  
Alessandro Olivi
Keyword(s):  
Cerebrospinal Fluid ◽  
Polyethylene Glycol ◽  
Fibrin Glue ◽  
Posterior Fossa ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
P Value ◽  
Posterior Fossa Surgery ◽  
Dural Closure ◽  
Fluid Leak

Abstract Objective: Incisional cerebrospinal fluid (CSF) leak remains a significant cause of morbidity, particularly after posterior fossa surgery, with ranges between 4 and 17% in most series. We aimed to determine whether the use of a new polyethylene glycol (PEG) dural sealant product (DuraSeal; Confluent Surgical, Waltham, MA) is effective at preventing incisional CSF leak after posterior fossa surgery. Methods: One hundred cases of posterior fossa surgery with the PEG dural sealant applied at the time of dural closure were prospectively observed from May 2005 to April 2006. All patients underwent posterior fossa craniotomy or craniectomy. Clinical histories were followed to document cases of incisional CSF leak, pseudomeningocele, meningitis, wound infection, and interventions required to treat a CSF leak or pseudomeningocele. A retrospective cohort of 100 patients treated in a similar fashion but with fibrin glue augmented dural closure served as controls. Results: In the PEG group, two of 100 (2%) patients developed an incisional CSF leak postoperatively. By comparison, 10 of 100 (10%) patients in whom fibrin glue was used developed an incisional CSF leak. This difference was statistically significant, with a P value of 0.03. There were no significant differences in the rates of pseudomeningocele, meningitis, or other postoperative interventions. Conclusion: The application of PEG dural sealant to the closed dural edges may be effective at reducing incisional CSF leak after posterior fossa surgery.

scholarly journals Sandwich wound closure reduces the risk of cerebrospinal fluid leaks in posterior fossa surgery

2016 ◽  
Vol 6 (2) ◽  
Author(s):  
Verena Heymanns ◽  
Abidemi W. Oseni ◽  
Ameer Alyeldien ◽  
Homajoun Maslehaty ◽  
Richard Parvin ◽  
...  
Keyword(s):  
New York ◽  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Wound Closure ◽  
Posterior Fossa Surgery ◽  
Dural Closure ◽  
Csf Leakage ◽  
Cerebrospinal Fluid Leaks ◽  
Closure Method ◽  
Csf Leaks

Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.

scholarly journals Evaluation of Non-Watertight Dural Reconstruction with Collagen Matrix Onlay Graft in Posterior Fossa Surgery

2016 ◽  
Vol 59 (1) ◽  
pp. 52 ◽  
Author(s):  
Varun R. Kshettry ◽  
Bjorn Lobo ◽  
Joshua Lim ◽  
Burak Sade ◽  
Soichi Oya ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Collagen Matrix ◽  
Posterior Fossa Surgery ◽  
Onlay Graft

Local Tolerance and Biodegradability of a Novel Artificial Dura Mater Graft Following Implantation Onto a Dural Defect in Rabbits

2020 ◽  
Vol 48 (6) ◽  
pp. 738-746
Author(s):  
Yuval Ramot ◽  
Sagi Harnof ◽  
Ido Klein ◽  
Netanel Amouyal ◽  
Michal Steiner ◽  
...  
Keyword(s):  
Dura Mater ◽  
Healing Process ◽  
Collagen Matrix ◽  
Dural Defect ◽  
Local Tolerability ◽  
Local Tolerance ◽  
Bovine Collagen ◽  
Tissue Healing ◽  
Dural Graft ◽  
Synthetic Grafts

Dura mater defects are a common problem following neurosurgery. Dural grafts are used to repair these defects; among them are biodegradable polymeric synthetic grafts. ArtiFascia is a novel synthetic and fibrous Dural graft, composed of poly(l-lactic-co-caprolactone acid) (PLCL) and poly(d-lactic-co-caprolactone acid). In this study, the biodegradability and local tolerance of ArtiFascia was evaluated in rabbits and compared with a bovine collagen matrix as a reference control. ArtiFascia implantation resulted in the formation of neo-dura at the site of implantation and recovery of the dural damage and the calvaria bone above. The implanted graft was completely absorbed after 12 months and the remaining macrophages were morphologically consistent with the anti-inflammatory M2-like phenotype, which contributes to tissue healing and are not pro-inflammatory. The site of the drilled skull bone had a continuous smooth surface, without exuberant tissue or inflammation and a newly formed trabecular bone formation indicated the healing process of the bone. These results support the local tolerability and biodegradability of ArtiFascia when used as a dural graft in rabbits. This study suggests that PLCL-based grafts including ArtiFascia are safe and effective to repair Rabbit Dura.

Ten-Year Experience of Dural Reconstruction Using a Collagen Matrix Inlay Graft in Posterior Fossa Surgery: A Propensity Score–Matched Study

2020 ◽  
Vol 141 ◽  
pp. e383-e388
Author(s):  
Kyung Hwan Kim ◽  
Bumsoo Park ◽  
Hyoung Soo Byoun ◽  
Jeongwook Lim ◽  
Hyon-Jo Kwon ◽  
...  
Keyword(s):  
Propensity Score ◽  
Posterior Fossa ◽  
Collagen Matrix ◽  
Posterior Fossa Surgery ◽  
Matched Study

scholarly journals Superficial siderosis of the central nervous system associated with incomplete dural closure following posterior fossa surgery: report of 3 cases

2015 ◽  
Vol 123 (5) ◽  
pp. 1326-1330 ◽  
Author(s):  
Ravi Kumar ◽  
Jeffrey T. Jacob ◽  
Kirk M. Welker ◽  
Fred M. Cutrer ◽  
Michael J. Link ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Posterior Fossa ◽  
Revision Surgery ◽  
Diagnosis And Treatment ◽  
Superficial Siderosis ◽  
Posterior Fossa Surgery ◽  
Dural Closure ◽  
The Central Nervous System

This report reviews a series of 3 patients who developed superficial siderosis following posterior fossa operations in which dural closure was incomplete. In all 3 patients, revision surgery and complete duraplasty was performed to halt the progression of superficial siderosis. Following surgery, 2 patients experienced resolution of their CSF xanthochromia while 1 patient had reduced CSF xanthochromia. In this paper the authors also review the etiology, pathophysiology, diagnosis, and treatment of this condition. The authors suggest that posterior fossa dural patency and pseudomeningocele are risk factors for the latent development of superficial siderosis and recommend that revision duraplasty be performed in patients with posterior fossa pseudomeningoceles and superficial siderosis to prevent progression of the disease.

scholarly journals Primary Dural Closure for Retrosigmoid Approaches

2017 ◽  
Vol 79 (04) ◽  
pp. 330-334 ◽  
Author(s):  
Garrett Venable ◽  
Mallory Roberts ◽  
Ryan Lee ◽  
L. Michael
Keyword(s):  
Posterior Fossa ◽  
Primary Closure ◽  
Chart Review ◽  
Tumor Resection ◽  
Retrospective Chart Review ◽  
Csf Leak ◽  
Dural Defect ◽  
Dural Closure ◽  
Lesion Type ◽  
Csf Leaks

Object Primary closure of posterior fossa dura can be challenging, and postoperative cerebrospinal fluid (CSF) leaks continue to represent a common complication of the retrosigmoid approach. We describe a simple technique to allow for primary closure of the dura following retrosigmoid approaches. The incidence of CSF leaks using this method is reported. Methods A retrospective chart review was conducted on all cases of retrosigmoid craniotomies performed by the senior surgeon from February 2009 to February 2015. The primary outcome was development of postoperative CSF leak or pseudomeningocele. Length of stay, lesion type, and other surgical complications were also reported. Results Eighty-six patients underwent a retrosigmoid craniotomy during the study period. The most common indications for retrosigmoid craniotomy were microvascular decompression (58%) and tumor resection (36%). No allo- or autografts to repair the dural defect were needed, and no lumbar drains were used. No patients developed CSF otorrhea, rhinorrhea, or incisional leak postoperatively. Conclusion Primary dural closure is possible in retrosigmoid approaches without the use of allo- or autografts and may prevent postoperative CSF leaks when combined with other posterior fossa closure techniques. Careful attention to the handling of the dural flap is necessary to achieve this.

Sign in / Sign up

Export Citation Format

Share Document