Abstract
Background: In cranial neurosurgery, primary watertight dural closure is the standard method of post-craniotomy dural repair. However, cerebrospinal fluid (CSF) leaks, pseudomeningoceles, postoperative infections, and dural scarring are possible complications, even when a meticulous technique is implemented. For this reason, materials that enhance the dura’s ability to create a watertight seal, inhibit the inflammatory response, and prevent disease transmission are sought. Dehydrated amniotic membrane (DAM) allograft appears to facilitate these properties, as studies have shown that it improves wound healing, prevents scar tissue formation, promotes epithelialization, and inhibits bacterial growth. We detail the use of a DAM allograft to augment dural closures for craniotomies.Methods: We conducted a pilot study, retrospectively reviewing our institution’s database of craniotomies that utilized DAM to supplement dural closure.Results: A total of 122 cases, including 18 initial craniotomies for infratentorial lesions, 102 initial craniotomies for supratentorial lesions, one re-do craniotomy for supratentorial recurrent glioma, and one craniotomy for an anterior skull base schwannoma used a DAM allograft to augment dural closure. Only one complication occurred (0.8% complication rate), which was a superficial wound infection requiring washout without craniectomy. No CSF leaks occurred.Conclusions: This pilot study demonstrates that dehydrated amniotic membrane allograft can be safely utilized as an adjunct during dural closures for craniotomies.
Highlights
After craniotomy with a dural opening, sutured watertight dural repair is the preferred method of closure, as it is believed to minimize the risk of cerebrospinal fluid (CSF) leakage and infection
A total of 122 cases (Table 1) using Dehydrated amniotic membrane (DAM) allografts was performed at our institution from August 2016 to February 2017 by the senior neurosurgeon (RJK)
Eighteen (14.8%) initial craniotomies for infratentorial lesions, 102 (83.6%) initial craniotomies for supratentorial lesions, one (0.8%) revision craniotomy for a supratentorial recurrent glioma, and one (0.8%) initial supratentorial craniotomy for an anterior skull base schwannoma used a DAM allograft to supplement dural closure
Summary
After craniotomy with a dural opening, sutured watertight dural repair is the preferred method of closure, as it is believed to minimize the risk of cerebrospinal fluid (CSF) leakage and infection. When a primary dural closure is not possible, neurosurgeons must repair the dura with a dural reinforcement material or substitute, such as an allograft, xenograft, or synthetic biomaterial, each with their respective drawbacks [2]. Autologous tissues, such as pericranium, temporal fascia, and fascia lata, avoid the risk of disease transmission and an immunologic rejection. Cerebrospinal fluid (CSF) leaks, pseudomeningoceles, postoperative infections, and dural scarring are possible complications, even when a meticulous technique is implemented For this reason, materials that enhance the dura’s ability to create a watertight seal, inhibit the inflammatory response, and prevent disease transmission are sought. We detail the use of a DAM allograft to augment dural closures for craniotomies
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