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J Neurol Surg A Cent Eur Neurosurg 2019; 80(01): 039-043
DOI: 10.1055/s-0038-1675565
Surgical Technique
Georg Thieme Verlag KG Stuttgart · New York

TachoSil Dural Reconstruction in Extracranial-Intracranial Bypass Surgeries

Julia Tews
1   Department of Neurosurgery, BG-Klinikum Bergmannstrost GmbH, Merseburger Straße 165, Halle 06112, Germany
,
Behnam Rezai Jahromi
2   Department of Neurosurgery, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
,
Christopher Ludtka
3   Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Stefan Schwan
4   Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Halle, Germany
,
Nakao Ota
5   Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
,
Hans Joerg Meisel
1   Department of Neurosurgery, BG-Klinikum Bergmannstrost GmbH, Merseburger Straße 165, Halle 06112, Germany
,
Rokuya Tanikawa
5   Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
,
Michael Lawton
6   Barrow Neurosurgical Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Felix Goehre
1   Department of Neurosurgery, BG-Klinikum Bergmannstrost GmbH, Merseburger Straße 165, Halle 06112, Germany
2   Department of Neurosurgery, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
› Author Affiliations
Further Information

Publication History

05 December 2017

14 May 2018

Publication Date:
15 November 2018 (online)

Also available ateRefMedOne
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Abstract

Background Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is a treatment option for hemodynamic insufficiency in the anterior cerebral circulation. Complications associated with extracranial-intracranial bypass surgeries are ischemic strokes caused by bypass failure, wound-healing disorders, and further issues from cerebrospinal fluid (CSF) leakage. CSF leakage can provide pathways for infection. It is well known in general neurosurgery that watertight closure of the dura mater is necessary to prevent such complications.

Objective To provide a technical description of TachoSil dural reconstruction in standard STA-MCA bypasses and their follow-up analyses.

Methods In this technical report with observational follow-up, the dura mater was closed partially by adaptive sutures, and the perforation site of the donor vessel was sealed with TachoSil. TachoSil is a collagen sponge covered with clotting factors that provides hemostatic and sealing effects.

Results Our study included eight cases of standard STA-MCA bypasses that had been operated between July 2015 and September 2016. Follow-up examinations were completed for all patients at 1 month and 6 months after surgery. Duplex and Doppler ultrasound demonstrated regular bypass patency in all patients without increased flow velocity at the perforation sites, which is a possible sign of stenosis. No wound-healing disorders or CSF leakage occurred. No cerebrovascular stroke events were observed.

Conclusion Duraplasty with TachoSil enables the elastic reconstruction of the dura perforation gap in standard extracranial-intracranial bypass surgeries.

Keywords

cerebral ischemia - dural closure - extracranial-intracranial bypass - STA-MCA bypass - TachoSil