Abstract
During the last 10 years, 41 patients with dural tear caused by anterior cranial fossa
bone fracture were treated surgically. Those treated conservatively were not included
in this series. The patients' mean age was 36 years. The average time of postoperative
observation was 15 months. Traffic accidents, as well as wounds caused by missiles
(shell fragments or bullets), blows, and falls were the mechanisms of injury. An autogenous
graft, followed by homologous (lyodura) and most recently by heterologous (lyoplant;
B. Braun Melsungen AG, Melsungen, Germany) implants, was used to repair the dural
lacerations. Fibrin adhesive was used to seal the sutures inserted between graft and
dural defect margins in a majority of cases. The following criteria are required for
the best dural substitute: uncontaminated tissue, histologic similarity to the local
dura mater, adaptability, quick rehidratation, waterproof closure and the dural margins
fast healing, and tensile strength easily resisting cerebrospinal fluid pressurization
in physiological and pathological conditions. To define the effects of different tissue
that could meet the above-mentioned criteria, we have undertaken a mechanical testing
of the dural substitutes' tensile strength followed by histologic examination, and
comparison with the dura mater of the anterior fossa region. Finally, we have paid
particular attention to the clinical results of these substitutes.
