Methods of Dural and Skull Base Treatment

Abstract

The dura mater belongs to the bradytrophic tissues of the body. Its healing process is slow and in the form of scarred connective tissue (Probst 1986; Ernst et al. 2004). As the arachnoid membrane heals considerably faster than the dura mater, a manifest liquorrhea may no longer be traceable. However, as long as the dura wound is not closed, the arachnoidal wound closure does not render sufficient protection against ascending infections from the region of the paranasal sinuses (Süss and Corradini 1984; Probst and Tomaschett 1990; Stammberger and Posawetz 1990). The aim of dural reconstruction is to achieve a watertight closure of the dural defect by doing a straightforward dural suture or a duraplasty using dural tissue substitutes. There are principally three possibilities of dural closure (Stammberger and Posawetz 1990; Stammberger 1991):

• Intradural treatment (underlay technique):

  Positioning of a transplant on the dural defect between the dura and the brain tissue

• Extradural treatment (overlay technique):

  Placing a transplant between bone and dura—the transplant acts as a splint for natural dural closure.

• Sandwich method:

  Intracranial and endonasal coverage of the dural defect in two layers intradural (underlay technique)—extradural (overlay technique) (sandwich method used in nasal surgery). Small and adaptable dural tears are closed extradurally using nonabsorbable sutures. The defects are covered by an additional autogenous transplant. Multiple dural tears or dural defects are covered with autogenous or allogenic or alloplastic transplants using continuous sutures and fibrin glue.