The Use of Tantalum Foil in the Subdural Space

Abstract

T IIE NEUROSURGICAL management of wounds of the central and peripheral nervous svstem sustained in modern warfare has been considerably facilitated 'by the introduction of tantalum. Its physical properties and inertness when in contact with body tissues have allowed its application in numerous forms, viz. plate, foil, wire and ribbon. Utilizing these different preparations, it has been possible to successfully repair cranial defects, secure hemostasis, perform accurate nerve suture and prevent postoperative adhesions (subdurally to avoid meningocerebral cicatrices; in the vicinity of peripheral nerve anastomoses and neurolyses; and extradurally in the spinal canal following disc surgery). In this communication, we are particularly interested in reporting our experiences following the use of tanta lum foil sut)durally in the prevention of post-traumatic and postoperative sequelae. The high incidence of convulsions following gunshot wounds of the head with dural penetration is well known. Many of these are undoubtedly due to the formation of a meningocerebral cicatrix. Prevention of the latter, therefore, is of extreme practical importance. Pudenz and Odom 3 have recently reviewed the literature and presented their experimental results on the various materials that are available for this purpose. These included the resorbable membranes (amnioplastin, Cargile and insu]toic membranes, films of 5 per cent polyvinyl alcohol) and tanta lum foil. The latter, particularly, evoked only a very minimal connective-tissue and inflammatory reaction with only slight encapsulation. At tachment was noted only along the margins of the capsule. These observations were made from a study of six experimental animals over a period of front 10 to 143 days. I)elarue, Linell and McKenzieJ on the contrary, do not advise the use of foil subdurally in head injuries with cortical damage on the basis of a similar experimental study. In all twelve animals, thickening of the dura overlying the tanta lum was found in periods of from 16 days to four and a half months following implantation. The arachnoid showed similar but less marked reactions. Early encapsulation of this material, however, was not seen until three and a half months in two animals. This process was so marked in three additional dogs that adhesions bound the foil to the subjacent cortex. Our experiences in man in this respect have corroborated the findings of Pudenz and Odom? rather than Delarue, Linell and McKenzie. 1 Ingraham and Bailey 2 have recently introduced fibrin film as a dural substitute. Ten experimental animals were sacrificed from ~4 hours to 6 months following its use. Only minimal tissue reactions were observed and the sub-