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Dural closure

Alexander Chern, Jacob B Hunter, Marc L Bennett
OBJECTIVE: To determine if cranioplasty techniques following translabyrinthine approaches to the cerebellopontine angle are cost-effective. STUDY DESIGN: Retrospective case series. PATIENTS: One hundred eighty patients with available financial data who underwent translabyrinthine approaches at a single academic referral center between 2005 and 2015. INTERVENTION: Cranioplasty with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws Main Outcome Measures: billing data was obtained for each patient's hospital course for translabyrinthine approaches and postoperative cerebrospinal fluid (CSF) leaks...
October 21, 2016: Otology & Neurotology
Ramesh Kumar, Frederic W B Deleyiannis, Corbett Wilkinson, Brent R O'Neill
OBJECTIVE The authors' goals in this study were to describe a series of dog attacks on children that required neurosurgical consultation and to better understand the pattern of injuries inflicted, the circumstances that place children at risk for attack, and the dog breeds involved. In addition, the authors review the surgical and medical management of these patients. METHODS The authors performed a retrospective review of all children requiring neurosurgical consultation for dog bite at a regional Level 1 pediatric trauma center over a 15-year period...
October 21, 2016: Journal of Neurosurgery. Pediatrics
Cord M Brundage, Rebecca A Packer, Matthew D Jones
OBJECTIVE: To describe the magnetic resonance (MR) image appearance of 5 hemostatic agents placed in the brain, and to review their clinical application. STUDY DESIGN: Descriptive ex vivo and in vivo study. ANIMALS: Canine cadavers (n=4), client-owned dogs (n=4). METHODS: Heads from 4 canine cadavers were used, each with 5 hemostatic agents placed in specific locations in the brain. Hemostatic agents were used in their native form in 2 cadaveric brains, and in 2 others the materials were saturated with fresh whole blood prior to placement to mimic application in a field of active hemorrhage...
September 23, 2016: Veterinary Surgery: VS
John S Kuo, Garni Barkhoudarian, Christopher J Farrell, Mary E Bodach, Luis M Tumialan, Nelson M Oyesiku, Zachary Litvack, Gabriel Zada, Chirag G Patil, Manish K Aghi
BACKGROUND: Numerous technological adjuncts are used during transsphenoidal surgery for nonfunctioning pituitary adenomas (NFPAs), including endoscopy, neuronavigation, intraoperative magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) diversion, and dural closure techniques. OBJECTIVE: To generate evidence-based guidelines for the use of NFPA surgical techniques and technologies. METHODS: An extensive literature search spanning January 1, 1966, to October 1, 2014, was performed, and only articles pertaining to technological adjuncts for NFPA resection were included...
October 2016: Neurosurgery
Hakan Erdogan, Bilal Kelten, Matem Tuncdemir, Salime Pelin Erturkuner, Hafize Uzun, Alper Karaoglan
AIM: The aim of this study was to evaluate the histopathological and biochemical impact and effectiveness of two hemostatic agents, Ankaferd blood stopper (ABS) and Microporous Polysaccharide Hemospheres (MPH), on epidural fibrosis in an experimental rat laminectomy model. MATERIAL AND METHODS: Twenty adult Wistar albino rats were divided into MPH-treated (n=6), ABS-treated (n=6) and control (n=8) groups. Laminectomy of the lumbar spine was performed in all animals and treatment groups were exposed to MPH and ABS while closure was applied in control group as per usual...
2016: Neurologia i Neurochirurgia Polska
Kiyoshi Ito, Tatsuya Seguchi, Takuya Nakamura, Akihiro Chiba, Takatoshi Hasegawa, Alhusain Nagm, Tetsuyoshi Horiuchi, Kazuhiro Hongo
BACKGROUND: Nonpenetrating titanium clips create no suture holes and thereby reduce cerebrospinal fluid leakage after dural closure. However, no data exists regarding metallic artifacts caused by these clips during postoperative neuroimaging. We aimed to evaluate clip-related artifacts on postoperative MR images of 17 patients who underwent spinal surgery. METHODS: A phantom study evaluated the size of metallic artifacts, while a clinical study evaluated the quality of postoperative spinal MR images...
August 29, 2016: World Neurosurgery
Ken Matsushima, Ryo Hashimoto, Masahide Gondo, Hirokazu Fukuhara, Michihiro Kohno, Hiroyuki Jimbo
BACKGROUND: Incidental durotomy is a relatively common complication in spinal surgeries, and treatment of persistent cerebrospinal fluid (CSF) leakage is still challenging, especially in cases for which "watertight" suturing is inapplicable. The usefulness of a non-vascularized perifascial areolar tissue (PAT) graft was recently emphasized for plastic and skull base surgeries. Its hypervascularity allows for early engraftment and long-term survival, and its flexibility is advantageous in fixing defects of complex shapes in limited surgical spaces...
August 20, 2016: World Neurosurgery
Collin M Torok, Raul G Nogueira, Albert J Yoo, Thabele M Leslie-Mazwi, Joshua A Hirsch, Christopher J Stapleton, Aman B Patel, James D Rabinov
PURPOSE: The purpose of this article is to present a case series of transarterial venous sinus occlusion for dural arteriovenous fistulas (DAVFs) of the transverse and sigmoid sinuses. MATERIALS AND METHODS: From 2006 to 2012, 11 patients with DAVF of the transverse and sigmoid sinuses were treated with transarterial closure of the affected venous sinus using ethylene vinyl alcohol copolymer (ONYX). The consecutive retrospective cohort included six female and five male patients with an age range of 30-79...
August 16, 2016: Interventional Neuroradiology
Hambra Di Vitantonio, Danilo De Paulis, Mattia Del Maestro, Alessandro Ricci, Soheila Raysi Dechordi, Sara Marzi, Daniele F Millimaggi, Renato J Galzio
BACKGROUND: Various materials have been proposed to obliterate dead spaces and to reconstruct dural defects during a neurosurgical approach. This study describes our technique of using the abdominal autologous fat graft and evaluates the complications and characteristics related to the use of this tissue during cranial procedures. METHODS: Autologous fat grafts were used in 296 patients with basicranial and convexity extraaxial tumors from April 2005 to January 2015...
2016: Surgical Neurology International
Verena Heymanns, Abidemi W Oseni, Ameer Alyeldien, Homajoun Maslehaty, Richard Parvin, Martin Scholz, Athanasios K Petridis
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...
April 26, 2016: Clinics and Practice
Felix J Paprottka, Nicco Krezdorn, Ramin Ipaktchi, Christine Radtke, Peter M Vogt
BACKGROUND AND AIM: Large skull base defects are extremely difficult to treat and have a severe impact on patients' physical appearance and functional aspects. These extensive defect zones are mainly caused by trauma, surgical interventions, or wide tumor excision. High-level microsurgical techniques are necessary to provide sufficient treatment. The aim of this study is to describe successful reconstructive strategies for surgical treatment. METHODS: Nine patients with skull base defects were treated in our department from 2008 to 2014 (n = 9)...
September 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Jonathan S Black, Jordan Deschamps-Braly, Arlen D Denny
PURPOSE: Cephalocranial disproportion is a symptomatic condition related to a volume discrepancy between the calvarial vault and the brain. Traditional expansion techniques are unfavorable in older children due to inadequate dural ossification, lack of bone pliability, and limited future growth potential. The authors review their experience using distraction to close bone defects in this setting. METHODS: A retrospective analysis was performed of all patients treated using distraction in this setting by a single surgeon...
September 2016: Journal of Craniofacial Surgery
Ercan Bastu, Cenk Yasa, Ozlem Dural, Bahar Yuksel Ozgor, Gamze Yilmaz, Funda Gungor Ugurlucan, Faruk Buyru, Saikat Banerjee
STUDY OBJECTIVE: To compare the effects of the laparoscopic approach versus the vaginal route for the management of vaginal cuff closure during total laparoscopic hysterectomy on female sexual function in premenopausal patients with benign gynecologic conditions. DESIGN: A prospective study with a randomized, double-blind design (Canadian Task Force Classification I). SETTING: A university hospital. PATIENTS: Patients who were scheduled to have total laparoscopic hysterectomy because of benign conditions...
September 2016: Journal of Minimally Invasive Gynecology
Han-Song Sheng, Nu Zhang, Jian Lin, Fen-Chun Lin, Bo Yin, Mao-de Wang
OBJECTIVES: Surgical management of cranial burst fracture (CBF) usually involves craniotomy to remove the devitalized brain tissues, followed by watertight repair of dural tears. However, there were times when the dural tear was so extensive that a substantially large bone flap would have to be removed in order to expose the retracted dural margins before it could be repaired. In such cases, strict dural repair would incur a significantly higher risk of damages to the surrounding neural tissues and severe bleeding, especially when the fracture was in the vicinity of eloquent cortical areas and sinus...
September 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Mansher Singh, Joseph A Ricci, Ian F Dunn, Edward J Caterson
BACKGROUND: Titanium cranioplasty is commonly used for surgical closure of skull defects post craniectomy. Superficial implantation of the mesh can result in discomfort, palpability, and in extreme patients, exposure of the mesh. Exposed titanium mesh can be complicated by infections and often requires implant revision or removal. Generally, the contour of the titanium mesh is camouflaged in the hairline of the patient and any aesthetic complication can remain inconspicuous. However, in the frontal bone position the thin hairless forehead skin often may not easily hide the contour of the underlying titanium mesh...
July 2016: Journal of Craniofacial Surgery
Francesco Tomasello, Felice Esposito, Rosaria V Abbritti, Filippo F Angileri, Alfredo Conti, Salvatore M Cardali, Domenico La Torre
BACKGROUND: Microvascular decompression (MVD) represents the most effective and safe surgical option for the treatment of trigeminal neuralgia since it was first popularized by Jannetta 50 years ago. Despite several advances have been proposed, the rate of complications as cerebellar and vascular injury, hearing loss, muscular atrophy, cerebrospinal fluid (CSF) leak, postoperative cutaneous pain and sensory disturbances, remain still actual and may negatively affect the outcome. We propose some technical nuances of the surgical procedure we used in our recent series...
June 29, 2016: World Neurosurgery
Roberto Centonze, Emiliano Agostini, Samantha Massaccesi, Stefano Toninelli, Letterio Morabito
BACKGROUND: A large variety of biological and artificial materials are employed in dural repair, each of them with major limitations. Autologous grafts have limited availability and require an additional incision and surgical time. Cadaveric preparations and heterologous materials entail the risk of iatrogenic transmission of prions, whereas synthetic substitutes have been reported to cause inflammatory reactions and graft rejection. An equine-derived pericardium membrane has been developed (Heart(®), Bioteck, Vicenza, Italy) with mechanical and safety-related features that could make it suitable for neurosurgical application...
July 2016: Asian Journal of Neurosurgery
Sang-Hyeop Jeon, Sang-Ho Lee, Yi Sheng Tsang, Tag-Geun Jung, Ki-Hyoung Moon, Gun Choi, Ketan Deshpande
STUDY DESIGN: A retrospective review. OBJECTIVES: To evaluate the therapeutic efficacy of the triple layer closure technique to establish watertight sealing without diversion of lumbar drainage, in preventing persistent incidental subarachnoid-pleural fistula and other neurologic complications related to excessive drainage of cerebrospinal fluid (CSF) after dural defect in transthoracic ossified posterior longitudinal ligament (OPLL) surgery. SUMMARY OF BACKGROUND DATA: Cerebrospinal fluid (CSF) leakage into the pleural cavity leads to unfavorable conditions for natural healing of incidental durotomy due to the negative pressure environment of the pleural space and lack of wound healing around the bony cavity near the decompressed spinal cord...
June 28, 2016: Clinical Spine Surgery
George M Ghobrial, Christopher M Maulucci, Matthew J Viereck, Sara Beygi, Ameet Chitale, Srinivas Prasad, Jack Jallo, Joshua Heller, Ashwini D Sharan, James S Harrop
STUDY DESIGN: Open-label Laboratory Investigational Study; Non-animal Surgical Simulation OBJECTIVES:: The authors perform a comparison of dural closure strength in a durotomy simulator across two different suture materials. SUMMARY OF BACKGROUND DATA: Incidental durotomy leading to persistent cerebrospinal fluid (CSF) leak adds considerable morbidity to spinal procedures, often complicating routine elective lumbar spinal procedures. Using an experimental durotomy simulation, the authors compare the strength of closure using Gore-tex™ with other suture types and sizes, using various closure techniques...
June 28, 2016: Clinical Spine Surgery
Kiyoshi Ito, Tatsuro Aoyama, Takuya Nakamura, Yoshiki Hanaoka, Tetsuyoshi Horiuchi, Kazuhiro Hongo
The authors report on a new method for removing dumbbell-shaped spinal tumors that avoids the risk of postoperative cerebrospinal fluid (CSF) leakage. Adequate visualization of the intra- and extradural components of the tumor is achieved with the use of separate dural incisions. First, the dura mater is opened along the dural theca to provide adequate visualization of the intradural portion of the mass; then, a second incision is made along the nerve root to remove the extradural component. Meticulous suturing is essential in intradural lesion cases; however, the dura mater is usually thin and fragile in such cases...
June 10, 2016: Journal of Neurosurgery. Spine
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