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Simplified Dural Reconstruction Procedure Using Biocompatible Polyglycolic Acid Felt with Autologous Abdominal Fat Grafts after a Transpetrosal Approach

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Title: Simplified Dural Reconstruction Procedure Using Biocompatible Polyglycolic Acid Felt with Autologous Abdominal Fat Grafts after a Transpetrosal Approach
Authors: Yamaguchi, Shigeru Browse this author
Terasaka, Shunsuke Browse this author →KAKEN DB
Okamoto, Michinari Browse this author
Ishi, Yukitomo Browse this author
Motegi, Hiroaki Browse this author
Kobayashi, Hiroyuki Browse this author →KAKEN DB
Houkin, Kiyohiro Browse this author →KAKEN DB
Keywords: Cerebrospinal fluid leakage
Dural reconstruction
Petrosal approach
Polyglycolic acid felt
Skull base surgery
Issue Date: Dec-2019
Publisher: Elsevier
Journal Title: World neurosurgery
Volume: 132
Start Page: E710
End Page: E715
Publisher DOI: 10.1016/j.wneu.2019.08.033
Abstract: BACKGROUND: Dural reconstruction after transpetrosal approaches is complicated because complete primary closure of presigmoid dura mater is difficult to achieve. To address this problem, we use biocompatible polyglycolic acid (PGA) felt (Durawave) to reconstruct dural defects. To evaluate the use of PGA felt in dural reconstruction, we compared these results with those after conventional duraplasty using autologous fascia grafts. METHODS: We retrospectively surveyed all cases involving a transpetrosal approach reported since 2013. In the conventional procedure, autologous fascia was fixed over the dural defect using stay sutures; any remaining dead space was obliterated by placing abdominal fat grafts. Since April 2017, we have used PGA felt instead of fascia. RESULTS: Of the 37 cases identified, 27 were reconstructed according to the conventional procedure, and the remaining 10 cases were reconstructed using PGA felt. Among the 27 conventional cases, 8 involved cerebrospinal fluid (CSF)-related complications, including 3 cases of rhinorrhea and 5 cases of subcutaneous fluid collection, and 2 cases (7%) required repair surgery. Of the 10 cases involving PGA felt, 1 case (10%) involved subcutaneous fluid collection and required repair surgery, and whereas the remaining 9 cases had no evidence of CSF leakage. In addition, the median dural reconstruction time using PGA felt was 9 minutes, significantly shorter than that when autologous fascia was used (median, 44 minutes). CONCLUSIONS: Using PGA felt for presigmoid dura simplifies dural reconstruction because it obviates the need to suture in a deep field. PGA felt has the potential to prevent CSF-related complications after transpetrosal approaches.
Rights: © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
http://creativecommons.org/licenses/by-nc-nd/4.0/
Type: article (author version)
URI: http://hdl.handle.net/2115/79851
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 山口 秀

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