Abstract
Decompressive craniotomy is a neurosurgical emergency procedure in which a large skull bone is removed and the dura matter is extensively opened. Duraplasty is required to avoid cerebrospinal fluid (CSF) leakage during the decompressive craniotomy. DuraGen® is a safe and effective type I collagen matrix graft, which is frequently used in decompressive craniotomy procedures. Since DuraGen® does not require labor-intensive suturing, the operative time is shortened by DuraGen® closure with sufficient tightness preventing CSF leakage. Recently, early cranioplasty is preferred to achieve efficient rehabilitation after decompressive craniotomy. Although evidence of efficacy and safety of DuraGen® has been increasing in the management of duraplasty, no reports have previously discussed the condition of DuraGen® during the second surgery (cranioplasty) at this early timing. DuraGen®-derived neodura develops a mature dura 1 year post its placement, and the neodura remain fragile at this early time point. A deconstructed fragile neodura may result in postoperative CSF leakage. Here, we illustrated a multilayered dural repair technique with DuraGen® to avoid disruption of the fragile neodura during early cranioplasty.
Highlights
DuraGen® -derived neodura develops a mature dura 1 year post its placement, and the neodura remain fragile at this early time point
Evidence of efficacy and safety of DuraGen® has been increasing in the management of duraplasty [10], no reports have previously discussed the condition of DuraGen® during a second surgery at this early timing
A deconstructed fragile neodura may result in postoperative cerebrospinal fluid (CSF) leakage
Summary
A 51-year-old woman presented with sudden-onset headaches, vomiting and abnormal consciousness level. The repaired dura was fixed with fibrin glue to prevent CSF leakage and migration of the grafts (Figures 1B and 2). The radially incised native dura is placed over the inlay graft. An adequate size of onlay graft is placed extradurally on top of the exposed inlay graft and native dura (3). The musculocutaneous flap was re-opened without irritating the radically incised native dura and inlay graft. No CSF leakage was observed post the cranioplasty procedure. This technique made the musculocutaneous flap dissection faster and potentially safer. She was discharged three weeks after the cranioplasty without any severe neurological sequelae
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
