Clinical Application of Artificial Dura Mater to Avoid Cerebrospinal Fluid Leaks after Microvascular Decompression Surgery

Abstract

Objective: Although technological advances combined with many surgical innovations have helped to minimize its occurrence, cerebrospinal fluid (CSF) leak still remains to be one of the most common postoperative complications following microvascular decompression (MVD) surgeries. The objectives of this study are 1) to detail our experience with the clinical application of artificial dura mater for the avoidance of CSF leaks in a group of 103 patients who underwent MVD surgeries and 2) to compare the results of CSF leak and deep wound infection between the group with and one without using artificial dura mater. Methods: From July, 2002 to June, 2004 217 consecutive patients who underwent MVD surgeries for hemifacial spasm or trigeminal neuralgia in our center were enrolled into this study. Among them, 103 patients underwent the application of artificial dura mater (Neuro-patch®) in the surgical closure procedure to prevent postoperative CSF leak. The handling techniques were detailed and the postoperative results were evaluated. The follow-up period was at least 6 months. Results: No postoperative CSF leak occurred in the group of patients receiving artificial dura mater whereas 6 cases of CSF leak (2 otorrhea, 2 rhinorrea and 2 CSF wound leak) were found in the group not receiving artificial dura mater. There was no statistical difference of wound infection rates found between these two groups, 1.9 % vs. 2.6 %. Conclusions: The use of the artificial dura mater in the closure procedure of MVD surgery seems to be a safe and effective way to prevent CSF leaks. However, further investigations on a larger number of cases still need to be done to substantiate its validity.

Key words

Artificial dura mater - cerebrospinal fluid leak - microvascular decompression

References

• 1 Mclaughlin M R, Jannetta P G, Clyde B L, Clyde B L, Subach B R, Comey C H, Resnick D K. Microvascular decompression of cranial nerves: lessons learned after 4400 operations.  J Neurosurg. 1999;  90 1-8
• 2 Kalkanis S N, Eskandar E N, Carter B S, Barker 2nd F G. Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes.  Neurosurgery. 2003;  52 1251-1261
• 3 Samii M, Gunther T, Iaconetta G, Muehling M, Vorkapic P, Samii A. Microvascular decompression to treat hemifacial spasm: long-term results for a consecutive series of 143 patients.  Neurosurgery. 2002;  50 712-718
• 4 Patel A, Kassam A, Horowitz M, Chang Y F. Microvascular decompression in the management of glossopharyngeal neuralgia: analysis of 217 cases.  Neurosurgery. 2002;  50 705-710
• 5 Broggi G, Ferroli P, Franzini A, Servello D, Dones I. Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis.  J Neurol Neurosurg Psychiatry. 2000;  68 59-64
• 6 Jodicke A, Winking M, Deinsberger W, Boker D K. Microvascular decompression as treatment of trigeminal neuralgia in the elderly patients.  Minim Invas Neurosurg. 1999;  42 92-96
• 7 Kabuto M, Kubota T, Kobayashi H, Handa Y, Tuchida A, Takeuchi H. MR imaging of cerebrospinal fluid rhinorrhea following the suboccipital approach to the cerebellopontine angle and the internal auditory canal: Report of two cases.  Surg Neurol. 1996;  45 336-340
• 8 Yamada K, Miyamoto S, Takayama M, Nagata I, Hashimoto N, Ikada Y, Kikuchi H. Clinical application of a new bioabsorbable artificial dura mater.  J Neurosurg. 2002;  96 731-735
• 9 Yamagata S, Goto K, Oda Y, Kikuchi H. Clinical experience with expanded polytetrafluoroethylene sheet used an artificial dura mater.  Neurol Med Chir. 1993;  33 582-585
• 10 Miyamoto S, Yamada K, Nagata I. Clinical application of new bioabsorbable artificial dura mater: a preliminary report.  J Artif Organs. 1998;  1 10-14
• 11 Malliti M, Page P, Gury C, Chomette E, Nataf F, Roux F X. Comparison of deep wound infection rates using a synthetic dural substitute (Neuro-patch) or pericranium graft for dural closure: A clinical review of 1 year.  Neurosurgery. 2004;  54 599-604