Abstract
Introduction
Following Simpson Grade 1 excision of large convexity meningioma there is often a need for synthetic dural substitutes.
Discussion
One problem with some of these grafts is that they lack tensile strength when wet and therefore sink into the cavity left following removal of the meningioma.
Conclusion
A simple method to prevent ‘sinking’ or sagging of such synthetic dural grafts is described and illustrated.
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Reference
Messing-Junger AM, Ibanez J, Calbucci F, Choux M, Lena G, Mohsenipour I, Van Calenbergh F (2006) Effectiveness and handling characteristics of a three-layer polymer dura substitute: a prospective multicenter clinical study. J Neurosurg 105(6):853–858 Dec
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The article describes a useful manner to prevent soft, very pliable dural replacement grafts from falling into a post-operative cavity. I have employed a similar technique for many years when using this type of graft, and similar products. The degree of post-operative dural loss of course determines the need, extent and organisation of the sutures. It should be borne in mind that isolated sutures can, when crossing exposed brain tissue, cause focal compression and especially when there is later cerebral swelling. The use of vicryl tape or other broader material, if available, has in my experience reduced the likleyhood of thin sutures cutting into exposed or bulging brain at the edges, in the fashion of a wire 'cheese slicer' causing surface damage.
I generally use dural 'hitch' stitches as part of surgical closure, but, as I am sure the authors are aware, there is no clear evidence of their ability to absolutely reduce bleeding complications.
James van Dellen
Imperial Healthcare NHS Trust, London
The authors present a simple and effective dural closure, following excision of a large tumour from the brain. In this way, postoperatively, the space between the dura (dural graft) and bone is significantly much smaller than it would be if the dura were repaired, so that the patch is simply sutured to the edges of the dura without support from underneath. Additional securing of the dura remains close to the bony flap, which is also possible when the dural patch or any other material is fixed to the bone flap with one or more stitches.
This report may be a useful reminder following a giant tumor, leaving a large hole in the brain behind. It is a simple, useful and practical technical note for practising neurosurgeons.
Vinko V. Dolenc
Universtiy Medical Centre Ljubljana, Slovenia
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Balasubramanian, C., Coley, E. & Whittle, I.R. Dural bridge sutures to prevent sinking of dural substitutes: technical note. Acta Neurochir (Wien) 151, 155–157 (2009). https://doi.org/10.1007/s00701-008-0167-3
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DOI: https://doi.org/10.1007/s00701-008-0167-3