Duraplasty in cranial base resection.
Complications of cerebrospinal fluid leakage following cranial base surgery are a predominant source of morbidity and mortality. The physical properties of the dura in this region, advanced patient age, previous irradiation, and the extent of tumor resection often limit or complicate the reconstructive options available to cranial base surgeons. We describe a technique that delivers vascularized tissue to the dural wound by transposing a dural flap based on the axial pedicle blood supply from the middle meningeal artery. This "duraplasty" can allow primary closure of defects at the cranial base. The donor site, which is less gravitationally dependent, more accessible, and often not affected by radiation therapy, can be closed using traditional methods. Advantages, disadvantages, and indications for this technique are discussed.
Shaffrey
M E
ME
Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville.
Persing
J A
JA
Shaffrey
C I
CI
Jane
J A
JA
D002555:Cerebrospinal Fluid; D004388:Dura Mater / Q000098:blood supply / Q000601:surgery*; D005205:Fascia / Q000637:transplantation; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D008576:Meningeal Arteries; D011183:Postoperative Complications / Q000517:prevention & control*; D013524:Surgical Flaps