[Dura-plasty in intracranial operations]

Abstract

Due to recent reports of slow-virus infections related to the use of lyophilized homologous grafts for duraplasty, we have reviewed the concept of dura substitution in cranial neurosurgery. The present study is based upon 2,115 cranial operations from 1991 to 1994. Frequency and complications of different grafts were investigated retrospectively. Within this time period, dura substitution was required with a frequency of 23.4%. In most cases, autologous tissue was used (47.5%), followed by lyophilized or dehydrated and gamma-radiated homologous cadaveric dura and fascia lata (41.8%). In addition, a synthetic polyesterurethane fleece was used since April 1994. In transsphenoidal approaches to the pituitary gland, autologous fascia lata with or without muscle was used exclusively (100%). In frontobasal trauma, plastic covering of the frontal skull base was performed predominantly by autologous galea-periost (84.8%). In contrast, homologous tissues were preferred for duraplasty in the posterior cranial fossa (77.9%). Complications, including CSF fistula, inflammation, pneumatocephalus, and pseudocysts were observed in 13.1% of operations with dura substitution. The rate of complications was highest in infratentorial (20.0%) and frontobasal operations (18.8%). Application of synthetic grafts for 9 months has reduced complications (6.3%). In conclusion, duraplasty should be generally performed by implantation of autologous grafts such as galea-periost or fascia lata. No restriction of this principle should be accepted for surgery in inflammation, after open brain injury, in the frontobasal region and in transsphenoidal approaches to the pituitary gland. In all other cases, insertion of synthetic grafts seems to be equal to the use of autologous tissue, and even superior in large dural defects.(ABSTRACT TRUNCATED AT 250 WORDS)