Watertight Dural Closure in Brain Surgery: A Simple Model for Training

Abstract

Background To avoid cerebrospinal fluid leaks and related possible complications, the dura mater should be meticulously closed after craniotomy procedures. Several techniques for duraplasty and different material for watertight closure have been described.

Objective To describe a device to be used for the training of neurosurgical procedures of duraplasty.

Technical Report A plastic dummy with a balloon was developed to test the efficacy of the watertight closure of the dura. The technical notes to reproduce the method have been described.

Conclusion The described model represents a new, simple, effective and affordable device to be used for neurosurgical training in the procedures of duraplasty and to test the efficacy of watertight closures.

Keywords

duroplasty - model - training - watertight closure

• References

• 1 Black P. Cerebrospinal fluid leaks following spinal or posterior fossa surgery: use of fat grafts for prevention and repair. Neurosurg Focus 2000; 9: e4
• 2 Matula C, Steiger C. Hemostasis and fleece-bound sealing in neurosurgery. Stuttgart, New York: Georg Thieme Verlag; 2005
• 3 Rengachary SS. Surgical repair of cerebrospinal fluid fistula: a modified technique. Am Surg 1981; 47: 268-271
• 4 Tschabitscher M, Di Ieva A. Practical guidelines for setting up an endoscopic/skull base cadaver laboratory. World Neurosurg 2013; 79 (S16) e1-7
• 5 Weinstein JS, Kenneth CL, Delashaw JB , et al. The safety and effectiveness of a dural sealant system for use with nonautologous duraplasy materials. J Neurosurg 2010; 112: 482-433
• 6 Berjano R, Vinas FC, Dujovny M. A review of dural substitutes used in neurosurgery. J Neurosurg 2010; 112: 428-433
• 7 Chaplin JM, Costantino PD, Wolpoe ME, Bederson JB, Griffey ES, Zhang WX. Use of an acellular dermal allograft for dural replacement: an experimental study. Neurosurgery 1999; 45: 320-327
• 8 Danish SF, Samdani A, Hanna A, Storm P, Sutton L. Experience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations. J Neurosurg 2006; 104 (1, Suppl): 16-20
• 9 Malliti M, Page P, Gury C, Chomette E, Nataf F, Roux FX. 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 2004; 54: 599-603 , discussion 603–604
• 10 Nakagawa S, Hayashi T, Anegawa S, Nakashima S, Shimokawa S, Furukawa Y. Postoperative infection after duraplasty with expanded polytetrafluoroethylene sheet. Neurol Med Chir (Tokyo) 2003; 43: 120-124 , discussion 124
• 11 Narotam PK, van Dellen JR, Bhoola KD. A clinicopathological study of collagen sponge as a dural graft in neurosurgery. J Neurosurg 1995; 82: 406-412
• 12 Raul JS, Godard J, Arbez-Gindre F, Czorny A. [Use of polyester urethane (Neuro-Patch) as a dural substitute. Prospective study of 70 cases]. Neurochirurgie 2003; 49 (2–3 Pt 1) 83-89
• 13 Vanaclocha V, Saiz-Sapena N. Duraplasty with freeze-dried cadaveric dura versus occipital pericranium for Chiari type I malformation: comparative study. Acta Neurochir (Wien) 1997; 139: 112-119
• 14 von Wild KR. Examination of the safety and efficacy of an absorbable dura mater substitute (Dura Patch) in normal applications in neurosurgery. Surg Neurol 1999; 52: 418-424 , discussion 425
• 15 Biroli F, Fusco M, Bani GG , et al. Novel equine collagen-only dural substitute. Neurosurgery 2008; 62 (3) (Suppl. 01) 273-274 , discussion 274
• 16 Esposito F, Cappabianca P, Fusco M , et al. Collagen-only biomatrix as a novel dural substitute. Examination of the efficacy, safety and outcome: clinical experience on a series of 208 patients. Clin Neurol Neurosurg 2008; 110: 343-351
• 17 Shaffrey CI, Spotnitz WD, Shaffrey ME, Jane JA. Neurosurgical applications of fibrin glue: augmentation of dural closure in 134 patients. Neurosurgery 1990; 26: 207-210
• 18 Acerbi F, Genden E, Bederson J. Circumferential watertight dural repair using nitinol U-clips in expanded endonasal and sublabial approaches to the cranial base. Neurosurgery 2010; 67 (2, Suppl Operative): 448-456
• 19 Boogaarts JD, Grotenhuis JA, Bartels RH, Beems T. Use of a novel absorbable hydrogel for augmentation of dural repair: results of a preliminary clinical study. Neurosurgery 2005; 57 (1, Suppl): 146-151 , discussion 146–151
• 20 Moskowitz SI, Liu J, Krishnaney AA. Postoperative complications associated with dural substitutes in suboccipital craniotomies. Neurosurgery 2009; 64 (3, Suppl): ons28-ons33 , discussion ons33–ons34
• 21 Barth M, Tuettenberg J, Thomé C, Weiss C, Vajkoczy P, Schmiedek P. Watertight dural closure: is it necessary? A prospective randomized trial in patients with supratentorial craniotomies. Neurosurgery 2008; 63 (4) (Suppl. 02) 352-358 , discussion 358
• 22 Ozisik PA, Inci S, Soylemezoglu F, Orhan H, Ozgen T. Comparative dural closure techniques: a safety study in rats. Surg Neurol 2006; 65: 42-47 , discussion 47
• 23 Preul MC, Bichard WD, Spetzler RF. Toward optimal tissue sealants for neurosurgery: use of a novel hydrogel sealant in a canine durotomy repair model. Neurosurgery 2003; 53: 1189-1198 , discussion 1198–1199
• 24 Filippi R, Derdilopoulos A, Heimann A, Krummenauer F, Perneczky A, Kempski O. Tightness of duraplasty in rabbits: a comparative study. Neurosurgery 2000; 46: 1470-1476 , discussion 1476–1477
• 25 Megyesi JF, Ranger A, MacDonald W, Del Maestro RF. Suturing technique and the integrity of dural closures: an in vitro study. Neurosurgery 2004; 55: 950-954 , discussion 954–955