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Dural closure

James Barger, Matthew Siow, Michael Kader, Katherine Phillips, Girish Fatterpekar, David Kleinberg, David Zagzag, Chandranath Sen, John G Golfinos, Richard Lebowitz, Dimitris G Placantonakis
Background: While effective for the repair of large skull base defects, the Hadad-Bassagasteguy nasoseptal flap increases operative time and can result in a several-week period of postoperative crusting during re-mucosalization of the denuded nasal septum. Endoscopic transsphenoidal surgery for pituitary adenoma resection is generally not associated with large dural defects and high-flow cerebrospinal fluid (CSF) leaks requiring extensive reconstruction. Here, we present the posterior nasoseptal flap as a novel technique for closure of skull defects following endoscopic resection of pituitary adenomas...
2018: Surgical Neurology International
Nasrin Yazdani, Mohammad Taghi Khorsandi-Ashtiani, Hamed Tashakorinia, Mahtab Rabbani Anari, Narges Mikaniki
Cerebrospinal fluid (CSF) leakages of the temporal bone may arise during mastoid surgery. The leakages can have multiple potential etiologies, for instance, using a cutting burr near the bony tegmen or monopolar electrocautery on the surface of the dura mater. In this paper, we introduced an effective and simple technique for the management of CSF leakages of the temporal bone. In a prospective case series, 36 patients (16 males and 20 females) who have had an experience of incidental or inevitable CSF otorrhea or otorhinorrhea during temporal bone surgery were selected...
March 2018: Indian Journal of Otolaryngology and Head and Neck Surgery
Kazuaki Morizane, Shunsuke Fujibayashi, Bungo Otsuki, Takeshi Sakamoto, Ryosuke Tsutsumi, Seiichi Odate, Akira Kusuba, Shuichi Matsuda
BACKGROUND: Although a valve-like mechanism has been proposed for expansion of spinal extradural arachnoid cysts (SEACs), the detailed mechanism remains unclear. Moreover, closure of the communication site is essential during surgery, but the method to identify the communication site remains unclear. The aim of this study was to determine the detailed mechanism of expanding SEACs through retrospective analysis of SEAC cases undergoing surgery and to elucidate the characteristics of the communication sites...
February 13, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Sivashanmugam Dhandapani, Madhivanan Karthigeyan
BACKGROUND: Endoscopy is increasingly being used for minimal invasiveness and panoramic visualization, with unclear efficacy and safety among spinal intradural lesions. OBJECTIVE: To compare micro-endoscopic and pure-endoscopic surgery for spinal intradural lesions. METHODS: Spinal intradural lesions operated by us using endoscopic/access ports were categorized 'micro-endoscopic' (predominant microscope use), or 'pure-endoscopic' (standalone endoscopy) surgery, and studied with respect to clinico-radiological features, techniques, peri-operative course, histopathology, clinical and radiological outcome at minimum of 3 months...
February 13, 2018: Spine Journal: Official Journal of the North American Spine Society
Christopher J Stapleton, Anoop P Patel, Brian P Walcott, Collin M Torok, Matthew J Koch, Thabele M Leslie-Mazwi, James D Rabinov, William E Butler, Aman B Patel
Background While technological advances have improved the efficacy of endovascular techniques for tentorial dural arteriovenous fistulae (DAVF), superior petrosal sinus (SPS) DAVF with dominant internal carotid artery (ICA) supply frequently require surgical intervention to achieve a definitive cure. Methods To compare the angiographic and clinical outcomes of endovascular and surgical interventions in patients with SPS DAVF, the records of all patients with tentorial DAVF from August 2010 to November 2015 were reviewed...
January 1, 2018: Interventional Neuroradiology
Agus Turchan, Taufiq Fatchur Rochman, Arie Ibrahim, Dyah Fauziah, Joni Wahyuhadi, M Arifin Parenrengi, Asra Al Fauzi, Erliano Sufarnap, Abdul Hafid Bajamal, Ferdiansyah, Heri Suroto, Purwati, Fedik Abdul Rantam, Adanti Wido Paramadini, Christianto Benjamin Lumenta
In the field of neurosurgery, often the dura mater cannot be sutured, and consequently, it requires a duraplasty procedure using a dural fascial graft. Since 1890, various materials have been researched as dura mater substitutes. Amniotic membrane, for example, is suitable as a dural graft material and has been used in neurosurgery since 2012. However, there has been little research on human patient's dural healing after the use of amniotic membrane in their duraplasty procedure. To address this gap, a clinical experimental study was undertaken to evaluate the human dural healing of 16 patients who had undergone duraplasty in decompressive craniectomy surgery at Dr...
February 7, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Nishant Goyal, Debarati Chattopadhyay, Prashant Durgapal, Rajesh Pasricha, Yamini Kansal, Ashok Kumar Mahapatra
Squamous cell carcinoma is known to occur as a serious complication of chronic burns, scars, and ulcers, but very rarely has it been reported to occur in a long-neglected meningocele. The authors wish to present the case of a 21-year-old man who presented to us when a previously asymptomatic meningocele developed a squamous cell carcinoma on the meningocele sac. The squamous cell carcinoma was excised in toto, followed by excision of the redundant meningocele sac. The neural placode was closed and dural closure done with an artificial dural patch...
February 2, 2018: Pediatric Neurosurgery
Daniel Azzam, Prasanth Romiyo, Thien Nguyen, John P Sheppard, Yasmine Alkhalid, Carlito Lagman, Giyarpuram N Prashant, Isaac Yang
OBJECTIVE: Duraplasty, a common neurosurgical intervention, involves synthetic or biological graft placement to ensure dural closure. The objective of this study is to advance our understanding of the use of dural substitutes in cranial surgery. METHODS: The PubMed database was systematically searched to identify studies published over the last decade (2007 to 2017) that described duraplasty procedures. Clinical data were disaggregated and analyzed for the comparisons of biological versus synthetic grafts...
January 25, 2018: World Neurosurgery
Mazda K Turel, Mena G Kerolus, John E O'Toole
Ossification of the ligament flavum in the thoracic spine is an uncommon radiological finding in the Western population but can present with back pain, varying degrees of myelopathy, and even paraplegia on occasion. The authors here present the case of a 50-year-old woman with a history of progressive back pain and symptoms of spontaneous intracranial hypotension who was found to have an ossified ligamentum flavum of the thoracic spine resulting in a dural erosion cerebrospinal fluid leak. Surgery involved removal of the ossified ligament flavum at T10-11, facetectomy, ligation of the nerve root, and primary closure of the dura, which resulted in complete resolution of the patient's symptoms...
January 26, 2018: Journal of Neurosurgery. Spine
Muhammad Arifin, Wihasto Suryaningtyas, Abdul Hafid Bajamal
PURPOSE: The purpose of this study is to review a large series of frontoethmoidal encephalocele (FEE) regarding their clinical presentation, the progressiveness of the mass volume, the skin stigmata as well as its surgical approach and post-surgical complications. METHOD: Records of all FEE patients treated in Soetomo General Hospital, Surabaya, and Charity Foundation Program from 2008 to 2015 were reviewed. Detailed patient's demography, clinical findings, radiology results, operative procedures, and complications were documented...
January 5, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Tristan van Doormaal, Ahmet Kinaci, Sander van Thoor, Saskia Redegeld, Wilhelmina Bergmann, Albert van der Zwan
BACKGROUND: Cerebrospinal fluid (CSF) leakage occurs in 4% to 32% of cranial surgeries and is associated with significant patient burden and expense. The use of sealant as an adjunct to primary dural closure is assumed to help prevent CSF leakage. OBJECTIVE: To examine the utility of different sealants for dural closure using an in Vitro model. METHODS: We evaluated 9 commonly used dural sealants, including Tachosil (Takeda Inc, Osaka, Japan), Adherus (Hyperbranch Inc, Durham, North Carolina), Duraform (Codman, Raynham, Massachusetts), Tissudura (Baxter, Deerfield, Illinois), Hemopatch (Baxter), TissuePatchDural (Tissuemed, Leeds, United Kingdom), Tisseel (Baxter), Duragen Secure (Integra, Plainsboro, New Jersey), and Duraseal, (Integra)...
December 21, 2017: Operative Neurosurgery (Hagerstown, Md.)
Tomohiro Kawaguchi, Kazuya Arakawa, Kazuhiro Nomura, Yoshikazu Ogawa, Yukio Katori, Teiji Tominaga
Endoscopic endonasal surgery, an innovative surgical technique, is used to approach sinus lesions, lesions of the skull base, and intradural tumors. The cooperation of experienced otolaryngologists and neurosurgeons is important to achieve safe and reliable surgical results. The bath plug closure method is a treatment option for patients with cerebrospinal fluid(CSF)leakage. Although it includes dural and/or intradural procedures, surgery tends to be performed by otolaryngologists because its indications, detailed maneuvers, and pitfalls are not well recognized by neurosurgeons...
December 2017: No Shinkei Geka. Neurological Surgery
Matthew T Neal, Randall J Hlubek, Alexander E Ropper, U Kumar Kakarla
When a dural defect is encountered during spine surgery, the dura mater must be reconstituted to minimize the occurrence of minor or major life-threatening sequelae. The neurosurgical literature lacks strategies for managing large dural defects encountered during surgery. The authors describe a 24-year-old man who developed cauda equina syndrome secondary to altered CSF flow in a large thoracolumbar arachnoid cyst. Surgical decompression and fenestration of the arachnoid cyst were performed, and the large dural defect was treated using a multilayer closure with collagen matrix, titanium mesh, and methylmethacrylate...
February 2018: Journal of Neurosurgery. Spine
Luana Antunes Maranha Gatto, Fernando Saurin, Gelson Luis Koppe, Zeferino Demartini
Background: Dural arteriovenous fistulas (DAVF) are unusual intracranial vascular malformations consisting of anomalous connections between meningeal arteries and dural sinuses or the veins that pass through them. They have variable clinical presentation and prognosis, which depend on their location and venous hemodynamics. Treatment is based on the closure of the abnormal connections, which is usually conducted via arterial and/or transvenous endovascular techniques. Case Description: We present a male patient who complained of headaches and left-sided pulsatile tinnitus due to DAVF from the external carotid artery branches draining directly into the ipsilateral sigmoid sinus...
2017: Surgical Neurology International
Wang Kai, Fan Xiaotong, Ren Jian, Wei Yukui, Xu Geng, Shan Yongzhi, Zhao Guoguang
Postoperative continuous bloody cerebral spinal fluid drainage with external ventricular drainage catheter could decrease the incidence of inflammation. But the drainage catheter left in place will interrupt the watertight dura matter closure. To prevent the related cerebrospinal fluid leakage and subgaleal pseudomeningocele after the catheter removal, we developed a patched closure method to seal the dural outlet of the drainage catheter with a favorable clinical outcome.
February 2018: World Neurosurgery
F T Rasul, D Tusnea, K M David
BioGlue® is an inert, bioadhesive surgical substance commonly used in spinal surgery to aid dural closure. The authors describe two cases in which the use of BioGlue® caused a local reaction culminating in the formation of a granuloma that caused cord compression several years after surgery in one case in which a second operation was required to relieve cord compression and remove the foreign material. In the other case spontaneous resolution occurred. To our knowledge these are the first reports of delayed spinal cord compression secondary to BioGlue®-induced granuloma...
January 2018: Acta Neurochirurgica
Masashi Nomura, Takahiro Ota, Mitsugu Ishizawa, Shinsuke Yoshida, Takayuki Hara
Cranioplasty is a comparatively simple neurosurgical procedure, and fatal complications are rare. This report describes two cases of critical brain swelling after otherwise uneventful cranioplasty. Both cases had subarachnoid hemorrhage and extremely similar clinical courses. They underwent decompressive craniotomy and clipping in the acute phase and had cranioplasty in the chronic phase, resulting in serious cerebral swelling and death. Deep venous sinus thrombosis was revealed in the autopsy for one case...
October 2017: Asian Journal of Neurosurgery
Chad A Glenn, Cordell M Baker, Joshua D Burks, Andrew K Conner, Adam D Smitherman, Michael E Sughrue
BACKGROUND: Dural repair in areas with limited operative maneuverability has long been a challenge in skull base surgery. Without adequate dural closure, postoperative complications, including cerebrospinal fluid (CSF) leak and infection, can occur. METHODS: We reviewed 53 consecutive surgical patients in whom a dural repair technique utilizing titanium microclips was performed from 2013 to 2016 at our institution. The repairs primarily involved difficult-to-reach dural defects in which primary suturing was difficult or impractical...
July 25, 2017: Operative Neurosurgery (Hagerstown, Md.)
Alexander G Weil, Sami Obaid, Chiraz Chaalala, Daniel Shedid, Elsa Magro, Romuald Seizeur, Michel W Bojanowski
BACKGROUND: Treatment of thoracic spinal dural arteriovenous fistulas (DAVFs) by microsurgery has recently been approached using minimally invasive spine surgery (MISS). The advantages of such an approach are offset by difficult maneuverability within the tubular retractor and by the creation of "tunnel vision" with reduced luminosity to a remote surgical target. OBJECTIVE: To demonstrate how the pitfalls of MISS can be addressed by applying 3-D endoscopy to the minimally invasive approach of spinal DAVFs...
July 25, 2017: Operative Neurosurgery (Hagerstown, Md.)
Gonçalo Novais, Bernardo Ratilal, Lia Pappamikail, Pedro Branco, Nuno Reis
BACKGROUND: Pseudomeningocele, an extradural collection of cerebrospinal fluid (CSF), has only been rarely reported to occur spontaneously in conjunction with isthmic spondylolisthesis (with lysis) in the lumbar spine. CASE DESCRIPTION: A 68-year-old male presented with low back pain and neurogenic claudication of several years duration without any history of trauma, epidural spine injections, or spine surgery. Lumbosacral magnetic resonance imaging (MRI) revealed a grade-I L4-L5 isthmic spondylolisthesis with spinal canal narrowing and a posterior paravertebral collection consistent with CSF...
2017: Surgical Neurology International
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