Abstract
Background
For dural plasty, several kinds of substitute materials are used clinically. Among these materials, pericranium is often used as a dural substitute since it is autologous and easy to harvest. However, it is rather thin and fragile, which makes it difficult to suture onto peripheral dura mater, especially when the defect is large.
Objective
We present a simple method of reinforcing the pericranium with fibrin sealant, which facilitates easier handling and suturing of the pericranium.
Methods
Fifteen patients who underwent surgical removal of meningioma, metastatic brain tumor and glioma attached to the dura mater were included in this analysis. To close the defects, we use ‘fibrin-sealed pericranium’. Herein we describe the method we employed in these cases. First, a standard skin flap is made by dissecting the subgaleal layer, leaving the periosteum on the bone. Second, fibrin sealant is evenly applied to the pericranium. Finally, the pericranium is cut along the reinforced area and dissected from the bone. The harvested pericranium is then used for closure of the dural defect. Some of these patients received further treatment as needed according to each pathology. The fibrin-sealed pericranium was examined histopathologically.
Results
Fibrin-sealing of pericranium made it durable enough to be handled and sutured easily. There were no significant complications or treatment failures, such as infection or CSF leakage.
Conclusions
Reinforcement of the pericranium with fibrin sealant is a simple and easy method to reduce the stress of dural plasty.
References
Danish SF, Samdani A, Hanna A, Storm P, Sutton L (2006) Experience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations. J Neurosurg 104(1 Suppl):16–20
Knopp U, Christmann F, Reusche E, Sepehrnia A (2005) A new collagen biomatrix of equine origin versus a cadaveric dura graft for the repair of dural defects--a comparative animal experimental study. Acta Neurochir (Wien) 147(8):877–887
Litvack ZN, West GA, Delashaw JB, Burchiel KJ, Anderson VC (2009) Dural augmentation: part I-evaluation of collagen matrix allografts for dural defect after craniotomy. Neurosurgery 65(5):890–897, discussion 897
Malliti M, Page P, Gury C, Chomette E, Nataf F, Roux FX (2004) Comparison of deep wound infection rates using a synthetic dural substitute (neuro-patch) or pericranium graft for dural closure: a clinical review of 1 year. Neurosurgery 54(3):599–603, discussion 603–594
Nakagawa S, Hayashi T, Anegawa S, Nakashima S, Shimokawa S, Furukawa Y (2003) Postoperative infection after duraplasty with expanded polytetrafluoroethylene sheet. Neurol Med Chir (Tokyo) 43(3):120–124, discussion 124
Parizek J, Mericka P, Husek Z, Suba P, Spacek J, Nemecek S, Nemeckova J, Sercl M, Elias P (1997) Detailed evaluation of 2959 allogeneic and xenogeneic dense connective tissue grafts (fascia lata, pericardium, and dura mater) used in the course of 20 years for duraplasty in neurosurgery. Acta Neurochir (Wien) 139(9):827–838
Sade B, Oya S, Lee JH (2011) Non-watertight dural reconstruction in meningioma surgery: results in 439 consecutive patients and a review of the literature. J Neurosurg 114(3):714–718
Sawamura Y, Asaoka K, Terasaka S, Tada M, Uchida T (1999) Evaluation of application techniques of fibrin sealant to prevent cerebrospinal fluid leakage: a new device for the application of aerosolized fibrin glue. Neurosurgery 44(2):332–337
Vanaclocha V, Saiz-Sapena N (1997) Duraplasty with freeze-dried cadaveric dura versus occipital pericranium for Chiari type I malformation: comparative study. Acta Neurochir (Wien) 139(2):112–119
Warren WL, Medary MB, Dureza CD, Bellotte JB, Flannagan PP, Oh MY, Fukushima T (2000) Dural repair using acellular human dermis: experience with 200 cases: technique assessment. Neurosurgery 46(6):1391–1396
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Comment
This is another useful contribution to the current debate on dural reconstruction. Autologous vs heterologous material? This concise report illustrates a reasonable compromise.
Domenico d'Avella
Padova, Italy
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Ito, H., Kimura, T., Sameshima, T. et al. Reinforcement of pericranium as a dural substitute by fibrin sealant. Acta Neurochir 153, 2251–2254 (2011). https://doi.org/10.1007/s00701-011-1077-3
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DOI: https://doi.org/10.1007/s00701-011-1077-3