Treatment for Postoperative Intracranial Infection after Duraplasty with Expanded Polytetrafluoroethylene Sheet

Introduction: Duraplasty with expanded polytetrafluoroethylene (ePTFE) sheet sometimes promotes infection. Dural reconstruction after removal of the ePTFE sheet is a significant problem.

Methods: Between 2002 and 2007, we treated 10 cases with ePTFE sheet as an artificial dura mater in which postoperative infection and refractory skin fistula developed after craniotomy. The ePTFE sheet and bone flap were removed completely. The dura mater was replaced with fascia lata graft in the initial three cases and it was not replaced in the next seven cases. Staged cranioplasty with artificial bone was performed in every case.

Results: Mean follow-up period was 21 months. Subdural empyemas were found in five cases. The other cases had epidural abscess without subdural empyemas. After the débridement, infection recurred in one case with dural replacement by fascia lata graft. No patient showed continuous cerebrospinal fluid leakage and postoperative infection after cranioplasty.

Conclusion: Complete removal of ePTFE sheet and bone flap is mandatory in the case of infection after craniotomy. And dural defect after removal of ePTFE sheet does not need to be replaced with any dural substitute. Staged cranioplasty can be performed with careful attention not to damage the membrane already formed on the brain surface.