Dural Graft Research Articles

Free rectus abdominis muscle flap reconstruction of the middle and posterior cranial base.

A multidisciplinary approach by the neurosurgeon, ENT surgeon, and plastic surgeon has been used in seven patients with extensive tumors involving the middle and posterior skull base. Wide resection of these tumors was accomplished, and the resultant defect of the cranial base was reconstructed using free rectus abdominis muscle flaps. The free muscle flap has been used to reconstruct defects in the posterior and lateral walls of the nasopharynx, obliterate the exposed paranasal sinuses, and cover tenuous dural repairs or dural grafts overlying the temporal lobe and posterior fossa to prevent cerebrospinal fluid leakage and ascending meningitis.

The safety of frontal sinus fat obliteration when sinus walls are missing

The dilemma of the management of a severely fractured frontal sinus when portions of the walls are missing presents a number of therapeutic options. The safety of placing a fat graft in such a sinus for obliteration when the graft will be required to obtain its nourishment from the scant vessels contained within the subcutaneous tissue or dura, or worse still, from a dural or bone graft is questioned. Clinical experience has suggested that such a procedure may not be safe. An experiment was performed in nine cats in which all of either the anterior or posterior frontal sinus wall was removed in eight sinuses, and 50% of either wall in the remaining ten. A standard osteoplastic flap and fat obliteration technique was then done. On microscopic examination 3 months later, 50% of the sinuses showed either reepithelialization, mucocele formation, infection, or some combination. This gives some support to the contention that patients undergoing fat obliteration after fracture in which frontal sinus walls are missing are in jeopardy of subsequent mucocele formation and infection.

The Use of Glycerol-Preserved Homologous Dura Mater Grafts in Cardiac Surgery: The Southampton Experience

Dura mater obtained from human cadavers and preserved in glycerol was used as patch grafts in various positions in the repair of acquired and congenital cardiac defects in 107 patients over a four-year period. The ages of the recipients ranged from 2 days to 75 years. The mean duration of preservation of the dura mater before use was 25.2 ± 8.1 weeks. The dural grafts were used as an aortic root gusset in 38 patients (35.5%) undergoing aortic valve replacement, for enlargement of the pulmonary artery or right ventricular outflow tract or both in 38 patients (35.5%), and for repair of coarctation of the aorta in 10 patients (9.4%). The grafts also were used for closure of atrial septal defects, for a variety of other congenital cardiac anomalies, and for replacement of segments of the aorta (2 patients). There were no complications attributable to the use of dura mater. Dura mater preserved in glycerol would seem to be a suitable material for repair of various cardiac defects because of its strength, low antigenicity, athrombogenicity, ease of handling, availability in large sizes, and rapid bonding to host tissue. However, long-term follow-up is important to assess the lasting properties of dura mater.

Management of lipomyelomeningoceles

Ninety-seven children with lipomyelomeningoceles were operated on at the Hospital for Sick Children between January, 1960, and December, 1982. The most common factor that caused these patients to seek help was the cosmetic effect of the mass on their back. However, 22 patients had urinary incontinence and 15 patients had a deformed or weak leg. Sixty of the 97 patients were female and 37 were male. The patients presented for treatment between 6 days and 18 1/2 years of age with a median age of 7 1/2 months. Fifty-six patients presented before the age of 6 months and 35 of these were perfectly normal at the time of presentation. On the other hand, of the 41 patients who were brought for treatment after the age of 6 months, only 12 were normal prior to surgery. When patients were appropriately treated at an early age, with their spinal cords untethered and their dura securely closed with a dural graft, then they remained unchanged neurologically or even improved. However, when treatment was delayed or not done appropriately then they were left with significant neurological sequelae. Lipomyelomeningoceles are serious lesions which without appropriate therapy can result in gross impairment of neurological function.

Surgical Reconstruction After Extensive Skull Base Surgery

Skull base surgery is a rapidly expanding surgical subspecialty bringing together the sophisticated surgical skills of the neurotologist-head and neck surgeon and the neurosurgeon. Newly described surgical approaches to the skull base have made possible greater surgical ablation of the skull base region, resulting in large defects and thus heightening the need for reconstructing these regions. Prevention of cerebrospinal fluid leaks is the most important aspect of reconstruction and is achieved most readily when possible by dural patch grafts of fascia lata, coverage of the dura with soft tissue, and preservation of the soft tissue utilizing skin or split thickness skin grafts. Soft tissue may be in the form of free fascia lata grafts, pedicled galeal flaps, or local or regional skin flaps. Defects of the skull base larger than a few square centimeters are best reconstructed with local or regional skin flaps or musculocutaneous flaps. These flaps lend sufficient structural support so that bone support is not usually required. Subsequent cranioplasty, when necessary, can provide protection to those regions of the brain that are more susceptible to blunt trauma.

Surgical treatment of spinal lipomas in infancy and childhood.

The clinical course and surgical treatment of 48 children with lipomatous lesions of spinal dysraphism are presented. Preoperative studies consisted of complete neurological examination, IVP, myelography and CT scan if indicated. The complete clinical course and surgical treatment of the children with lipomatous lesions of the lower spine is reviewed. The surgical aim was to free all intra- and extradural adhesions by dural grafting if necessary. The results of surgical treatment are dependent upon the time of treatment (as early as possible), the location and extent of the malformation and the quality of surgical treatment.

Postoperative Komplikationen bei 126 Fällen basilärer Impression und Arnold-Chiarischer Mißbildung

Within a period of ten years we operated on 126 cases of basilar impression and/or Arnold-Chiari malformation. Two surgical techniques were employed for decompression of the posterior fossa. In the group I (64 cases) the operation consisted of craniectomy and the dura mater was left open and was fixed to the lateral musculature. The technique of the group II (62 cases) consisted in endotracheal intubation without flexion of the head, position of the head without anterior flexion during the operation and plastic closure of the dura. The dural graft was employed to create more space at the craniocervical joint, to avoid cerebrospinal fluid fistula and to restore the integrity of the dura as a protection for the nervous structures of the posterior fossa. The frequency of postoperative complications and mortality observed in group II was definitely less than in the group I.

Microsurgical intradural lysis and Silastic dural patch grafting in lumbar adhesive arachnoiditis

Microsurgical intradural lysis and Silastic dural patch grafting in lumbar adhesive arachnoiditis

Spinal Lipomas in Infancy and Childhood

The clinical course of 42 children with lipomatous lesions of the lower spine is reviewed. Good neurological exam, IVP and myelography are considered essential components of the preoperative studies. The surgical aim is to free all intra- to extradural adhesions with dural grafting, if necessary. The results suggest that early corrective surgery within the first few weeks to months of life is the most satisfactory approach to preserving normal neurological and urological function in these children. 88% of children not operated on early developed progressive loss of neurological function and while delayed surgery frequently stopped progression of the disease it rarely returned the children to a normal state.

Long-Term Followup of Surgical Treatment of Cervical Spondylotic Myelopathy

Fifty-five patients with progressive, worsening cervical spondylotic myelopathy were surgically treated and followed from 2 to 20.5 years (mean 7 years). The biomechanical factors impinging on the spinal cord were clarified mainly by air myelography. Twenty-six patients underwent anterior interbody fusion by the Cloward technique which was used for removal of large midline masses, kyphosis angulation, single-level and double-level osteophytes or rarely for unstable subluxations. Twenty-nine patients underwent cervical laminectomy at C3 through C7; the majority were also treated with a dural graft to enlarge the dural tube in instances of vertebral retrolisthesis, osteophytes at three or more levels, pathological lordosis, or advanced vertebral body ankylosis. Ultimate success or failure of the surgical procedure could not be predicted by the preoperative presence or absence of most numerous complaints or findings. However, presence of sphincter disturbance and excessive lower extremity weakness was associated with a postoperative worsened result. A trend of improvement in disability after anterior interbody fusion and a tendency to late worsening in disability following cervical laminectomy were significant. In some instances, late worsening occurred as long as 8 to 12 years after improvement and plateau.

Proceedings: Spinal dural patch grafts inexperimental animals.

Proceedings: Spinal dural patch grafts inexperimental animals.

Unusual hematomas outside the spinal cord. Report of two cases.

✓ Two unusual hematomas outside the spinal cord are reported. One lay on both sides of a synthetic dural graft and was enclosed by regenerating dura. The other occurred within the leaves of the dura in a patient who had recently been under anticoagulation therapy.

Fate of dura mater homografts when replacing the anterior wall of the right atrium and when implanted in the right atrial cavity

Of the ten dogs in which dura mater homografts were used to replace large defects of the anterior wall of the right atrium, nine survived and one died. The dura graft soon retracted and was replaced by fibrous tissues which increased excessively the thickness of the newly formed atrial wall. Of the six dogs whose grafts were implanted between anterior wall and septum of the right atrium, three survived. The retraction of the graft was still greater and the fibrous and chondromatous replacement of the graft was excessive and areas of ossification were present.