Dural repair using autologous fat: Our experience and review of the literature

Abstract

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. The adipose tissue was removed from the paraumbilical abdominal region and was transformed into a thin foil. When possible, a watertight suture was made between the dural or bone edge with a fat graft. We always used fibrin glue to reinforce the dural closure.

Results: Complications occurred between 2 days and 1 year following procedure. Cerebrospinal fluid leaks were found in 11 cases. No case of mortality, pseudomeningoceles, fistula, infections, bacterial meningitides, or lipoid meningitides was reported. No patient required removal of the graft. No adhesion was observed between the brain and the autologous fat. Other fat-related complications observed were 2 cases of fat necrosis in the abdomen and 2 cases of abdominal hemorrhage.

Conclusion: The technique of harvesting and applying fat grafts is fairly simple, although it must be performed meticulously to be effective. Our experience has led us to believe that the use of fat grafts presents low morbidity and mortality. However, a neurosurgeon should never forget the possible late or early complications related to the use of fat grafts.

Keywords: Autologous fat graft; dural repair; dural substitute; watertight suture.

Figure 1

The fat graft can be used after being flattened with the use of a surgical hammer and is transformed into a thin foil (a). For the dural reconstruction, the fat is positioned below the free dural edge and sutured (b). When there is no free dural margin, the fat is positioned below the edge of the bone and then fixed (c) The fat can be turned on the sutured dural edge, thus forming another layer (d). At the end, the entire suture is reinforced with fibrin glue (e, f)

Figure 2

A 47-year-old male patient with “recidive chordoma,” arising from the posterior wall of the petrous apex, was operated. The lesion was exposed through a left petrosal retrolabyrinthine approach. The reconstruction of the approach was performed with autologous fat graft (a), fibrin glue and titanium mesh with the same shape of the mastoid process of the temporal bone (b and c). The postoperative computed tomography of the head in three-dimensional rendering showed the approach and its reconstruction (d). The follow-up at 1 year did not show any complication

Figure 3

A 63-year-old female patient with “psammomatous meningioma” (WHO 1) originating from the floor of the anterior cranial fossa was operated. Through a left frontotemporal approach, a huge meningioma arising from the olfactory grove was exposed and removed (a and b). The floor of the anterior cranial fossa eroded by the lesion and the dura mater of the frontal convexity were reconstructed with abdominal fat graft avoiding cerebrospinal fluid fistula (c and d). The follow-up at 1 year did not show any complication