title: Time-sparing and effective procedure for dural closure in the posterior fossa using a vicryl mesh (Ethisorb).
abstract: BACKGROUND
  Dural defects and cerebrospinal fluid (CSF) leaks are a common problem following posterior fossa surgery. The management includes either nonoperative management (e.g. external lumbar drainage) or surgical re-exploration.
  
  
  OBJECTIVE
  We present our surgical, clinical and histopathological experience of dural closure in the posterior fossa. In order to avoid CSF leaks we developed a simple but effective and time-sparing method using a well-cut sheet of a vicryl-poly-pdioxanone mesh (Ethisorb) covering the whole defect of the craniectomy. Additional fibrin glue or sealant is not necessary. Special attention was focused upon the frequency of postoperative complications, in particular infection rate and CSF leaks.
  
  
  METHODS
  85 patients were treated with vicryl mesh as dural substitute after posterior fossa surgery due to distinct pathologies. An illustrative case is presented. RESULTS. In none of the patients a postoperative infection was observed. Four patients presented postoperative CSF leakage and were treated by percutaneous lumbar drainage. Three of the patients improved completely, requiring no additional treatment. Only in one case defect covered by a vicryl mesh, a surgical reexploration became necessary.
  
  
  CONCLUSIONS
  We consider the vicryl mesh (Ethisorb) as an ideal dural substitute especially for the dural closure of the posterior fossa.
authors.affiliation: Department of Neurosurgery. University Hospital and School of Medicine. Gottingen. Germany.
authors.forename: I
authors.initials: I
authors.lastname: Reyes-Moreno
authors.forename: R
authors.initials: R
authors.lastname: Verheggen
mesh_terms: D020341:Absorbable Implants; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000601:surgery; D002528:Cerebellar Neoplasms / Q000556:secondary / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local; D011091:Polyesters; D011100:Polyglycolic Acid; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D012086:Reoperation; D013353:Subdural Effusion / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D013396:Suction; D013526:Surgical Mesh
chemical_list: C460779:Ethisorb; D011091:Polyesters; D011100:Polyglycolic Acid