Neurology India · 2025
Autologous Dura For Dural Defect Repair: A Technical Note.
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Rai Survendra Kumar R, Dandpat Saswat K, Jadhav Dikpal, Bhambere Sagar, Bhatia Kushal, Gajbhiye Nikhil K, Goel Atul H
Аннотация
BACKGROUND: Quest for finding ideal graft material for covering dural defect continues. Dura mater (DM)/pachymeninges consists of two layers; hence possibility of splitting this layer has been explored.
OBJECTIVE: Microsurgical splitting of dura into two layers for covering the dural defect.
MATERIALS AND METHODS: Splitting of DM with number 15 surgical blade was carried out on ten cadavers. Splitting the dura into two distinct layers was possible in every specimen paving way for implementing in routine neurosurgical practice. This technique was implemented in covering accidental dural defects in seven cases with defects ranging from 1 cm to 3.5 cm. All cases were followed up for potential complications in the long run.
RESULTS: Harvesting autologous dural graft by splitting it into two layers was possible with number 15 scalpel in autopsy specimen and routine neurosurgical practice. All dural defects were repaired without any complication with follow-up of more than 1 year.
CONCLUSIONS: Best replacement of dural defect is by dura itself. The technique of harvesting autologous dura by splitting into two layers is easy, inexpensive, and devoid of all graft-related complications found till date. Splitting of dura is technically demanding but possible in small- to medium-sized dural defects. This technique has inherent limitations arising due to the amount of surrounding dura available depending on the size of craniotomy and the size of the dural defect. This procedure cannot become a substitute for cases requiring the extensive sacrifice of the dura, especially during meningioma surgery. This technique emphasis value of good microsurgical techniques.
OBJECTIVE: Microsurgical splitting of dura into two layers for covering the dural defect.
MATERIALS AND METHODS: Splitting of DM with number 15 surgical blade was carried out on ten cadavers. Splitting the dura into two distinct layers was possible in every specimen paving way for implementing in routine neurosurgical practice. This technique was implemented in covering accidental dural defects in seven cases with defects ranging from 1 cm to 3.5 cm. All cases were followed up for potential complications in the long run.
RESULTS: Harvesting autologous dural graft by splitting it into two layers was possible with number 15 scalpel in autopsy specimen and routine neurosurgical practice. All dural defects were repaired without any complication with follow-up of more than 1 year.
CONCLUSIONS: Best replacement of dural defect is by dura itself. The technique of harvesting autologous dura by splitting into two layers is easy, inexpensive, and devoid of all graft-related complications found till date. Splitting of dura is technically demanding but possible in small- to medium-sized dural defects. This technique has inherent limitations arising due to the amount of surrounding dura available depending on the size of craniotomy and the size of the dural defect. This procedure cannot become a substitute for cases requiring the extensive sacrifice of the dura, especially during meningioma surgery. This technique emphasis value of good microsurgical techniques.