title: Safety of the nonabsorbable dural substitute in decompressive craniectomy for severe traumatic brain injury.
abstract: BACKGROUND
  Artificial dural substitutes are increasingly being used in decompressive craniectomy to prevent peridural fibrosis and facilitate cranioplasty for patients with head injury. The safety of the dural substitute should be systemically evaluated. We focus on Neuro-Patch (B. Braun, Boulogne, France), a nonabsorbable substitute and commonly used by neurosurgeons.
  
  
  METHODS
  In this retrospective study, 132 patients undergoing 135 craniectomies and cranioplasties for traumatic brain injury were enrolled. We subdivided the operations into two groups on the basis of whether Neuro-Patch was used (N = 50) or not (N = 85). Risk factors of neurosurgical site infection were assessed first. Then, we compared the occurrence of infective, hemorrhagic, and hydrodynamic morbidities after craniectomy and cranioplasty between the two groups.
  
  
  RESULTS
  The incidence of neurosurgical site infection after craniectomy or cranioplasty showed no intergroup difference (p = 1.000). Postoperatively, extra-axial hematoma, which consists of subdural or epidural hematoma, occurred in 9 of 50 craniectomies (18.00%) with Neuro-Patch and 3 of 85 craniectomies (3.53%) without Neuro-patch, which was significantly different (p = 0.009). The rates of hydrodynamic morbidities (subdural hygroma or cerebrospinal fluid leakage) after the procedures were similar between the two groups.
  
  
  CONCLUSIONS
  The use of Neuro-Patch does not increase the incidence of neurosurgical site infection and hydrodynamic complications, including subdural hygroma and cerebrospinal fluid leakage, after decompressive craniectomy or cranioplasty for severe traumatic brain injury. However, extra-axial hematoma at the site of craniectomy is more often encountered in patients with Neuro-Patch and forms a compressive lesion on the adjacent brain.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan. newlupin2001@yahoo.com.tw
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Huang
authors.forename: Tao-Chen
authors.initials: TC
authors.lastname: Lee
authors.forename: Wu-Fu
authors.initials: WF
authors.lastname: Chen
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications / Q000473:pathology / Q000601:surgery*; D056424:Decompressive Craniectomy; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011091:Polyesters / Q000627:therapeutic use*; D012189:Retrospective Studies; D013524:Surgical Flaps; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D014520:Urethane / Q000627:therapeutic use*
chemical_list: D001672:Biocompatible Materials; D011091:Polyesters; D014520:Urethane