Posterior Fossa Dura OnarÖmÖnda "gç Kapak" Yöntemi: Cerrahi Teknik ve Tek Merkezli Klinik Tecrübemiz

Amaç: Posterior fossa cerrahisi sonrasÖ hastalarda dura onarÖmÖndaki baLarÖsÖzlÖk beyin omurilik sÖzÖntÖsÖna ba?lÖ olarak kesi yeri iyileLmesine engel olabilmekte ve cerrahiye ba?lÖ morbidite oranlarÖnÖ artÖrabilmektedir. Bu çalÖLmanÖn amacÖ, "iç kapak" yöntemi olarak isimlendirdi?imiz duraplasti iLlemini anlatmak ve bu yöntemi uyguladÖ?ÖmÖz hastalarÖn klinik sonuçlarÖnÖ, klasik dura tamiri yaptÖ?ÖmÖz hastalarÖn sonuçlarÖyla karLÖlaLtÖrarak klinik tecrübemizi aktarmaktÖr. Gereç ve Yöntem: ÇalÖLmaya posterior fossa patolojisi nedeniyle opere edilen ve duraplasti yapÖlan 30 hasta dahil edildi. Hastalar, klasik dura tamiri yapÖlan (Grup 1) ve duralarÖ "iç kapak" yöntemiyle tamir edilen (Grup 2) grup olmak üzere iki grupta incelendi. Bulgular: Klasik dura tamiri yapÖlan (Grup 1) hastalarÖn 3' ünde beyin omurilik kaça?Ö izlenirken, iç kapak yöntemiyle dura onarÖmÖ yapÖlan (Grup 2) hastalarda izlenmedi. Tekni?imizi uyguladÖ?ÖmÖz gruptaki hastalarÖn hastanede ortalama kalÖL süreleri di?er gruba göre 7 gün daha az olarak hesaplandÖ. Sonuç: Tekni?imizin en büyük avantajÖ dura tamiri sÖrasÖnda sütür i?nesine ba?lÖ geliLen ufak deliklerin sa?lam dura tarafÖndan kapatÖlmasÖnÖ sa?lamasÖdÖr. Tekni?imiz, uygulanabilirli?i ve etkinli?i açÖsÖndan dura tamirinde güvenilir bir yöntemdir

"Inner Flap" Method in the Reconstruction of Posterior Fossa Dura: Surgical Technique and Single Center Clinical Experience

Aim: Failure in reconstruction of dura in posterior fossa surgeries may result in cerebrospinal fluid leakage and thus hinder wound healing and increase surgical morbidity rate. The aim of this study was to describe a new duraplasty method termed as "inner flap" method and reporting our clinical experience by comparing the results of this method with other standard classical duraplasty procedures. Material and Method: Thirty patients operated due to posterior fossa pathology were included in our study. These patients were divided into 2 groups whose duras were reconstructed by standard method (Group 1) and our technique "inner flap" (Group 2). Results: In 3 patients whose duras were reconstructed by standard technique (Group 1), cerebrospinal leakage was observed while none of the patients in group 2 had any wound healing problems. Mean average hospital stay of patients in group 2 was calculated 7 days shorter than patients in group 1. Conclusion: Most important advantage of our technique is that it provides closing minor holes due to suture needle by intact dura. Our technique is a safe method due to its effectivity and applicability.

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1. Yasargil MG, Fox JL: The microsurgical approach to acoustic neurinomas. Surg Neurol 1974;2:393-398.
2. Parizek J, Sercl M, Michl A, et al. Posterior fossa duraplasty in children: remarks on surgery and clinical and CT follow-up. Childs Nerv Syst 1994;10:444-449.
3. Culley DJ, Berger MS, Shaw D, et al: An analysis of factors determining the need for ventriculoperitoneal shunts after posterior fossa tumor surgery in children. Neurosurgery 1994;34:402-408.
4. Cain JE, Dryer RF, Barton BR. Evaluation of dural closure closure techniques - Suture methods, fibrin adhesive sealant and cyanoacrylate polymer. Spine 1988;13:720-725.
5. Danish SF, Samdani A, Hanna A, et al. Experience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations J Neurosurg (1 Suppl Pediatrics) 2006;104:16-20.
6. Verheggen R, Schulte-Baumann l, Hahm G, et al. A New Technique of Dural Closure - Experience with a Vicryl Mesh. Acta Neurochir (Wien) 1997;139:1074-1079.
7. Kurpad SN, Cohen AR: Posterior fossa craniectomy: an alternative to craniectomy. Pediatr Neurosurg 1999;31:54-57.
8. Kanna K, Gnanalingham KK, Lafuente J, et al. Surgical procedures for posterior fossa tumors in children: does craniotomy lead to fewer complications than craniectomy? J Neurosurg 2002;97:821-826.
9. Thammavaram KV, Benzel EC, Kesterson L. Fascia lata graft as a dural substitute in Neurosurgery. South Med J 1990;83:634-636.
10. Pudenz RH, Odom GL. Meningocerebral adhesions. An experimental study of the effect of human amniotic membrane, amnioplastin, beef allantoic membrane, Cargile membrane, tantalum foil and polyvinyl alcohol films. Surgery 1942;12: 318-344.
11. Robertson RCL, Peacher WG. The use of tantalum foil in the subdural space. J Neurosurg 1948;2:281-284.
12. San-Galli F, Darrouzet V, Rivel J, et al. Experimental evaluation of collagencoated vicryl mesh as a dural substitute. Neurosurgery 1992;30:396-401.
13. Sharkey PC, Usher FC, Robertson RCL, Pollard C. Lyophilized human dura mater as a dural substitute. J Neurosurg 1958;15:192-198.