The use of a reconstituted collagen foil dura mater substitute in paediatric neurosurgical procedures--experience in 47 patients.
BACKGROUND
CSF leakage is a common complication of neurosurgical procedures, with defective dural suture thought to be the most frequent cause. We report our experience with a new collagen foil (TissuDura, Baxter Healthcare SA, Switzerland) utilized as dural substitute in paediatric neurosurgical procedures.


METHODS
TissuDura was used in children consecutively operated on at the department of paediatric neurosurgery, Catholic University, Rome, from March 2004 to August 2007. Children underwent surgical procedures in supratentorial, infratentorial and spinal compartments. In supratentorial and spinal procedures, the dural graft was used according to the overlay technique. In the posterior fossa procedures, the underlay technique was used.


RESULTS
Forty-seven patients received TissuDura during surgery. Thirty-one patients underwent surgery for the removal of posterior fossa tumours, nine for supratentorial tumours and seven for spinal dysraphisms. No CSF leakage was observed following the use of TissuDura in supratentorial procedures. Two post-operative CSF leaks occurred in patients who had undergone spinal surgery. No post-operative hydrocephalus was noted in these two surgery groups. Three cases of CSF leakage occurred in patients who had undergone posterior cranial fossa surgery. All 3 cases had an associated supratentorial ventricular dilation present prior to the removal of the tumour (one case) or occurring after the tumour excision (two cases). No clinically evident adverse reactions directly related to TissuDura were observed.


CONCLUSIONS
The main advantages of TissuDura were its apparent ability to prevent CSF leakage when utilized in a specific subset of patients, and the absence of reactions or postoperative infections.
Paediatric Neurosurgery, Catholic University Medical School, Rome, Italy. benedettaludovica@virgilio.it
Benedetta Ludovica
BL
Pettorini
Gianpiero
G
Tamburrini
Luca
L
Massimi
Giovanna
G
Paternoster
Massimo
M
Caldarelli
Concezio
C
Di Rocco
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003094:Collagen / Q000627:therapeutic use*; D000075202:Contraindications; D003388:Cranial Fossa, Posterior / Q000601:surgery; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D007223:Infant; D008297:Male; D008567:Membranes, Artificial; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D019292:Skull Base Neoplasms / Q000601:surgery; D016135:Spinal Dysraphism / Q000601:surgery; D013131:Spine / Q000601:surgery; D013353:Subdural Effusion / Q000517:prevention & control*; D015173:Supratentorial Neoplasms / Q000601:surgery; D013530:Surgical Wound Infection / Q000517:prevention & control; D016896:Treatment Outcome
D008567:Membranes, Artificial; D003094:Collagen