Volume : VIII, Issue : V, May - 2018

A study to evaluate the efficacy of various dural substitutes in dural reconstruction

Dr Shashivadhanan

Abstract :

Introduction: The duramater is a very important structure in the craniospinal cavity which maintains the internal milieu of the ain and protects the ain from external invasion. A good water tight closure of dura ensures aneffective safe guard against cereospinal fluid (CSF)leak and subsequent infection. An ineffective dural closure leads to avoidable morbidity and mortality.

Materials & methods: A retrospective study was conducted in a single institute from September 2015 to Sept 2017 to evaluate the efficacy of Available dural substitute. This included Fiin sealant,collagen based dural substitute,synthetic dural substitutes and synthetic sealants .They were used as a  standalone or in combination with autologous duroplasty.The efficacy was compared for two weeks following surgery.Parameterschecked  postoperatively were CSF leak,local infection/inflammation,seizures or systemic signs of hypersensitivity. Preoperatively the user friendliness and time taken to control CSF leak were evaluated and conclusions were drawn.

Observation: In all a total of 553 cases were included in the study and  200 casesunderwent auto graft duroplasty,Collagen based dural substitute was used in 135 cases,fiin sealant in 177 cases , Tissue Patch ( synthetic adhesive sealant) in 33 cases,Goretex synthetic patch in 05 cases and PolyTetraFlorEthylene(PTFE)patch in 03 cases.43% of duroplasties was carried out using auto graft as a standalone, while 57% required an additional supplementation with one or two of the available substitutes.

Result: Collagen based dural substitutes had a success rate of 92.6% while autologous dural repair group showeda success of 91%. Although fiin sealant group had a success rate of 95% it was mostly used as an adjunct and only in 15 cases as a standalone .The success rates with synthetic C SF sealant, Synthetic patch(G patch) and PTFE  graft were 87.2%,80% and 66.7% respectively.

Conclusion: The present study suggests that Collagen baseddural substitutes offer a definite advantage to the surgeon in effectively control in postoperative CSF leak. Its use in appropriate setting offers a definite advantage in improving the postoperative outcomes.

Keywords :

Article: Download PDF   DOI : 10.36106/ijar  

Cite This Article:

Dr Shashivadhanan, A study to evaluate the efficacy of various dural substitutes in dural reconstruction, INDIAN JOURNAL OF APPLIED RESEARCH : Volume-8 | Issue-5 | May-2018

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