Postoperative subdural hematoma with blood flow from an epidural hematoma through a tear at the suture point of an artificial dura substitute.

OBJECTIVE

We have recently seen cases of postoperative epidural and subdural hematomas after duraplasty with an artificial dura substitute. In these cases, the epidural hematoma flowed into the subdural space through a tear at the suture point of the artificial dura substitute. In this study, whether such hematomas are specific to a certain artificial dura substitute was investigated, and the cause and risk factors were examined.

METHODS

In our institute, 46 patients underwent brain tumor extirpation with duraplasty with an artificial dura substitute; Gore-Tex and SEAMDURA were used as the artificial dura substitutes. Patients with postoperative hemorrhage after brain tumor extirpation with duraplasty with an artificial dura substitute were retrospectively analyzed. Moreover, suture strength was compared experimentally between Gore-Tex and SEAMDURA.

RESULTS

In patients who underwent brain tumor extirpation with duraplasty with an artificial dura substitute, the rate of postoperative hemorrhage was 8.6%. Epidural and subdural hematomas were seen in four patients after tumor extirpation with duraplasty with SEAMDURA, but there were none with Gore-Tex. Exposure of the superior sagittal sinus at craniotomy, older age, and longer operative time were seen more frequently in patients with hematoma than in patients without hematoma. The strength of the suture point was significantly weaker with SEAMDURA than with Gore-Tex (P = 0.00016).

CONCLUSIONS

Postoperative epidural and subdural hematomas seem to be specific for SEAMDURA and may be caused by the weak suture strength of SEAMDURA. In cases of duraplasty, a nonabsorbable artificial dura substitute may be suitable.