And if all three layers are torn, then the cerebrospinal fluid (CSF), a plasma fluid that cushions the brain and spinal cord can leak out. 2006 Feb;22(2):139-44. doi: 10.1007/s00381-005-1232-3. SYNTHECEL® Dura Repair Dural Closure After Posterior Fossa Surgery Case StudyCase Study. Objective . Clinically proven One product choice for excellent onlay or suture performance Excellent handling Non-animal derived, no risk of transmissible diseases Non-pyrogenic MR safe Conformable SYNTHECEL Dura Repair thickness is similar to human dura2,3 and conforms to the brain. Ann Transl Med. J Neurosurg 2009;111(2):380-386. Seeking a cure, EU-funded researchers have developed a new surgical approach and the materials to repair damaged spinal discs, potentially helping many sufferers enjoy better, more productive lives. Major headache, nausea, and light sensitivity can develop after surgery. [Dura-plasty in intracranial operations].  |  Patients manifest severe headaches that are exacerbated by upright posture. Dura Mater Repair. Yamada K, et al. Vanaclocha V, Saiz-Sapena N. Acta Neurochir (Wien) 1997;139(2):112-119. Since there was still active leak she underwent Endoscopic closure of the same. Keywords endoscopy, durotomy, complications, lumbar, biportal Introduction Incidental durotomy is one of the common complications occurring during spine surgery.1-4 Cerebrospinal fluid (CSF) leakage induces headache, nausea, intracranial hypotension, … J Neurosurg 2006;104(1 Suppl):16-20. NIH 2013; 18(4):1335 -1343. Dural tear. Authors W L Warren 1 , M B Medary, C D Dureza, J B Bellotte, P P … A dural tear is a complication of spine surgery in which the thin covering over the spinal cord (called dura mater) is nicked by the surgeon’s instrument. Upon incising with the smooth sizers, I noted a small linear opening in the dura along the course of the left L5. Surg Neurol 1999;52(4):418-424. The principles of management of dural tears are discussed, in the acute setting as well as cases when the tears have been missed at the time of surgery and present as a pseudo meningocoele or as a persistent draining CSF fistula. Duraplasty, a common neurosurgical intervention, involves synthetic or biological graft placement to ensure dural closure. In addition, CSF can be seen leaking from the wound, or a subcutaneous collection may be noted. BACKGROUND: In spinal surgery, repair of the dura is difficult when it is torn or fragile or is ossified as in cases with ossification of posterior longitudinal ligament. ArtiFascia® graft will be placed in areas where the native dural layer was damaged or missing. CSF or spinal fluid leaks can be troublesome to patients and to surgeons. J Neurosurg 2008;109(2):215-221. von Wild KR. How to Cite this article: Kothari M, Shah K, Nene A. Incidental Dural Tears during Spine Surgery: Prevention and Management. Therapies & Procedures We describe an effective surgical technique in primary repair of the spinal dura during minimally invasive spine surgery (MISS). Journal of Neurosurgery 2011;114(3):714-718. The materials chosen for this experiment were autologous fat, a polyester fiber mesh (Mersilene) and siliconecoated Dacron (Dura Film). Durepair Dura Regeneration Matrix Durepair™ Regeneration Matrix is a non-synthetic dura substitute used to repair defects in the dura. The objective of this study is to advance our understanding of the use of dural substitutes in cranial surgery. Efficacy and safety of a collagen matrix for cranial and spinal dural reconstruction using different fixation techniques. This site uses cookies to store information on your computer. BackgroundAfter cerebrospinal fluid (CSF) fistula repair, the goal of watertight sealing may not always be achieved, causing postoperative CSF leakage. Dura mater repair, commonly used in neurosurgical procedures, uses dural substitutes to repair defects in the dura. When operating in and around the nervous system (such as while performing spinal surgery), one of the structures that is present, and particularly delicate, is the dura. Dura mater is a thick membrane made of dense irregular connective tissue that surrounds the brain and spinal cord. Although it is a rare complication, the dura may get injured or tear during spinal surgery resulting in the leakage of cerebrospinal fluid (CSF), which normally surrounds the brain and spinal cord. USA.gov. There were no significant differences in complication rates among the 3 types of dural substitutes. The pericranium may be too small to cover a large defect in the dura and harvesting fascia lata may cause considerable discomfort to a patient’s leg.6-12 Dural substitutes have the benefit of convenience and are available in large 5-inch x 8-inch sheets (4-inch x 5-inch in CE regulated geographies). There is a published association of dural tears with smoking, diabetes, more than three epidural steroid injections 6 months prior to surgery, trauma, and revision surgery. By using the site, you consent to the placement of these cookies. If that happens, watch out! Figure 3: It is very advantageous to mobilize the dura away from the operative trajectory using retention sutures implanted in the base of the dura closest to the brain. One is the “watertight” closure, and the other, which is less popular in practice, the nonwatertight closure. Repair of dural laceration If a dural tear nevertheless occurs, it can be repaired by a standard dural closure technique eg, using standard stitches. ArtiFascia® will be applied via a routine and well-known procedure, using a suturing technique. Dural Repair Market to 2027 – Global Analysis and Forecast by Type (Biological Dural Repair, Synthetic Dural Repair); Application (Neurosurgery, Spine Surgery, Others); End User (Hospitals, Ambulatory Surgery Centers, Others) and Geography You may at any time change the settings regarding cookies. LIQOSEAL ® is indicated for use as an adjunct to standard methods of cranial dural repair to provide a watertight closure of the dura mater and reduce cerebrospinal fluid (CSF) leakage. Cerebrospinal fluid (CSF) leakage is a widely recognized complication after … Allografts were more frequently used in decompression for Chiari malformations compared with xenografts and synthetic grafts (P < 0.001). Chiari decompression surgery removes bone at the back of the skull to widen the foramen magnum and create space for the brain. Dura mater substitutes in the surgical treatment of meningiomas. 2008 Aug;109(2):215-21. doi: 10.3171/JNS/2008/109/8/0215. Dural tears are among the most commonly seen complications in spine surgery. Retention sutures placed along the edges of the dural flap are not very effective for mobilizing the dura and the underlying muscle and soft tissues. Zerris et al. Narotam PK, Jose S, Nathoo N, et al. When it comes to dural reconstruction following meningioma surgery (or following any neurosurgical procedure), there are two schools of thought and practice. The dura overlying the herniated tonsils is opened and a patch is sewn to expand the space, similar to letting out the waistband on a pair of pants. Dural Closure After Posterior Fossa Surgery Case StudyCase Study. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. adapted a technique that was originally described for arthroscopic surgery and nicely describe their way of closing the dura using a micropituitary rongeur and a 5-0 Prolene suture (Ethicon, Inc., Somerville, NJ). Neurosurgery 2000;46(6):1391-1396. Collagen matrix (Dura-Gen) in dural repair: analysis of a new modified technique. Koot, J.H. However, recent … SYNTHECEL Dura Repair is an assured and versatile solution for your dura reconstruction needs. Operating through 16-mm tubes, we have successfully used the Scanlan endoscopic dural repair set (Scanlan International, St. Paul, MN), as suggested by … Authors Daniel Azzam 1 , Prasanth Romiyo 1 , Thien Nguyen 1 , John P Sheppard 1 , Yasmine Alkhalid 1 , Carlito Lagman 1 , Giyarpuram N … Mine is from an ACDF surgery. The dura is a watertight sac of tissue that covers the spinal cord and spinal nerves. Lyophylized Dura Patch Repair of Congenital Diaphragmatic Hernia: Occurrence of Relapses By V.C.M. A surgery in 10/06 led to a leak at L3 under the ventral surface and under the nerve root. Any time surgery is done on the spine, there is a risk that the dura will get torn or damaged. Attempts have been made to repair it and failed. 1994 Jun;26(3):140-5. doi: 10.1097/01376517-199406000-00006. Epub 2018 Jan 31. J Neurosci Nurs. Dural Repair in Cranial Surgery Is Associated with Moderate Rates of Complications with Both Autologous and Nonautologous Dural Substitutes World Neurosurg. (Abstract Full Text HTML) (Download … Dural repair with four spinal sealants: focused review of the manufacturers' inserts and the current literature Spine J. Neurological J of Biomed Mat Rsch 2007; 83B(2):580-588 (Canine Study). Please enable it to take advantage of the complete set of features! Effective complete resection of intradural extramedullary tumors has been accomplished through minimally invasive spine surgery. The pain and discomfort is very difficult to live … Dural repair using acellular human dermis: experience with 200 cases: technique assessment Neurosurgery. Problems included the persistence of cerebrospinal-fluid fistulas in four patients and a late symptomatic pseudomeningocele in one, all requiring reoperation and meticulous closure of the dura. November 2, 2020 at 12:51 pm; Are … This spine surgery lecture covers dural repair techniques and the management of CSF Fistulae. HHS The dura and the bone that separates it from the sinuses can develop a breach that allows fluid to leak into the sinuses and emerge as a clear drainage from the nose or ear, or a flow of salty-tasting liquid in the throat. Stendel R, Danne M, Fiss I, Klein I, Schilling A, Hammersen S, Pietilae T, Jänisch W, Hopfenmüller W. J Neurosurg. Enables gold standard treatment. Modern techniques to repair complex dural defects employ … Some 30 % of European workers suffer from back pain, the top work-related disorder reported by the European Agency for Safety and Health at Work. There's a risk of a dural tear occurring during all types of spinal surgery, including lumbar decompression surgery. V alsalva maneuvre (PEEP 40) 8. But … 3, 4 Additionally, ossifications of spinal ligament, high-speed drill, and … The objective of this study is to advance our understanding of the use of dural substitutes in cranial surgery. Torn Dura Repair 09-20-2007, 11:59 AM. Warren WL, et al. Kizmazoglu C, Aydin HE, Kaya I, Atar M, Husemoglu B, Kalemci O, Sozer G, Havitcioglu H. J Korean Neurosurg Soc. Stendel R, et al. We describe an effective surgical technique in primary repair of the spinal dura during minimally invasive spine surgery (MISS). We utilized the approach to treat head injury patients complicated with optic nerve compression and cerebrospinal fluid leakage (CSF). 2019 May;7(10):217. doi: 10.21037/atm.2019.01.04. Most studies in the literature indicate that long-term outcomes are not negatively affected, provided that the tears are diagnosed early and managed appropriately. Danish SF, Samdani A, Hanna A, Storm P, Sutton L. J Neurosurg. Delayed cauda equina compression after spinal dura repair with BioGlue: magnetic resonance imaging and computed tomography aspects of two cases of "glue-oma". Barber SM, Fridley JS, Konakondla S, Nakhla J, Oyelese AA, Telfeian AE, Gokaslan ZL. Sutured repairs are the best known way to prevent persistent CSF leaks. AccessGUDID - DURA-GUARD Dural Repair Patch (00085412531007)- Dura-Guard is prepared from bovine pericardium which is cross-linked with glutaraldehyde. Eleven cases of basal skull fracture complicated with either optic nerve … After intradural repair, a small intradural patch was fixed with fibrin glue to the suture line and an extradural patch was placed on the site of the CSF leak. DePuy Synthes SYNTHECEL® Dura Repair Case Study Patient Pro˜ le A 23-year-old female with a known family history of neuro˜ bromatosis 2 (NF2) presented to the emergency room with worsening headache, ataxia, dysphagia, diplopia, and numbness on the right side of her face over a period of a … The pericardium is procured from cattle originating in the United States. Amir A., et al. DuraStat is a surgical device that enables high-quality, gold standard dural repairs with efficiency; even when access is limited. Chou et al. It is the outermost of the three layers of membrane called the meninges that protect the central nervous system. B one removal until you see the whole dural tear 2. 1, 2 Many conditions facilitate dural tears including thinned dura, prior spinal surgery, dural fibrosis, spinal stenosis, and spinal bifida. Would you like email updates of new search results? The effect of vancomycin powder on human dural fibroblast culture and its implications for dural repair during spine surgery OBJECTIVE Surgical site infections (SSIs) are a major source of morbidity after spinal surgery. Bergmeijer, and J.C. Molenaar Rotterdam, The Netherlands 49 During an 8-year period, 71 neonates with congenital diaphragmatic hernia were admitted to the Sophia Children's Hospital. Methods: Update my browser now. If the tear isn't identified and repaired at the time of surgery, it can lead to cerebrospinal fluid (CSF) leaking after the procedure. Dural tears that are not noted at the time of surgery often present in the postoperative period. With an updated browser, you will have a better Medtronic website experience. Dural graft substitutes are used when the opening in the dura is too large to be sutured together.1 There are many ways the dura can become damaged, including severe head injury, tumor ingrowth (meningioma), or a surgeon’s need to open the dura for access to the brain or spinal cord during invasive surgical procedures. Of these 23 patients, four had cervical tumors, eight thoracic tumors, and eleven lumbar … Despite this, there still up to 30% chance of leakage after surgery. J Neurosurg 2002;96(4):731-735. Lauvin MA(1), Zemmoura I(2), Cazals X(3), Cottier JP(3). Sade B, et al. Confirmation that the fluid is CSF can be gained by testing the fluid for beta-2 transferrin. Today, neurosurgeons often use a graft and a liquid sealant to repair the Dura and prevent cerebral-spinal fluid (CSF) leakage after neurosurgeries. Please post your story. SYNTHECEL Dura Repair is intended for single patient use only. The composing polymer mix provides the optimal strength and resilience to endure the fluctuating intradural fluid pressures and maintain durable adherence to the dura mater.  |  SYNTHECEL Dura Repair is an assured and versatile solution for your dura reconstruction needs. Incidental durotomy is the most frequent complication during spinal surgery. (PDF) Dural Repair in Cranial Surgery Is Associated with Moderate Rates of Complications with Both Autologous and Nonautologous Dural Substitutes PDF | … SYNTHECEL Dura Repair should be stored at room temperature; must not be frozen (5°C/41°F) or exposed to temperatures above 40°C/104°F. This site needs JavaScript to work properly. Dural Repair Market to 2027 – Global Analysis and Forecast by Type (Biological Dural Repair, Synthetic Dural Repair), Application (Neurosurgery, Spine Surgery, Others), End User (Hospitals, Ambulatory Surgery Centers, Others) and Geography D ural closure 6. This study provides greater insight into duraplasty practices and highlights the moderate complication rate associated with the procedure. Clinically proven One product choice for excellent onlay or suture performance Superior handling No adhesions* Non-animal derived, no risk of transmissible diseases Non-pyrogenic MR safe Conformable SYNTHECEL Dura Repair thickness is similar to human dura1,2 and conforms to the brain. Based on AlloDerm's performance in other … The practice of dural closure, like many surgical techniques and applications, is largely based on personal … Hernia & Abdominal Wall; Plastic & Reconstructive Surgery ; Optics; Surgical Amniotics; View all in Surgical Reconstruction; Surgical Instruments. Dural Repair in Cranial Surgery Is Associated with Moderate Rates of Complications with Both Autologous and Nonautologous Dural Substitutes January 2018 DOI: 10.1016/j.wneu.2018.01.115 If leakage of CSF occurs, this may affect the patient’s quality of life, at a time when maintaining function and good outcome is paramount. Comparison of Biomechanical Properties of Dura Mater Substitutes and Cranial Human Dura Mater : An In Vitro Study. After implantation, the porous fibrous structure of ArtiFascia® … :Spinal CSF Leak 7cm /RIH questions; Surgery on T1 calcified disc; Headaches after surgery ; Dr S called... dural reduction surgery?? The remaining edges of the dura may be tented up to … Yu, F, et al. COVID-19 is an emerging, rapidly evolving situation. Results: Certainty in Watertight Dural Closure for the Reduction of CSF leakage. Spine … Your surgeon will be aware of the risk of … Here, we report the … Spinal surgery is clearly not to be undertaken by or on the weak of heart; having said that, the vast majority of patients have no complications that require such intricate skills to manage and repair. Spine 2004;29:2861–7. Duraplasty, a common neurosurgical intervention, involves synthetic or biological graft placement to ensure dural closure. Supraorbital keyhole surgery is a limited surgical procedure with reduced traumatic manipulation of tissue and entailing little time in the opening and closing of wounds. In a series of 641 consecutive patients who underwent lumbar decompression surgery, Wang et al 45 reported 88 dural tears, a rate of 14%. SYNTHECEL Dura Repair is an assured and versatile solution for your dura reconstruction needs. The dura mater may be damaged by trauma or excising during intracranial or spinal surgery., To date, cerebrospinal fluid leakage followed by dura damage is still an intractable complication due to its various secondary complications , dural repair has recently garnered increased attention with the progress of the spinal surgery and neurosurgery. Journal of Orthopaedic Complications Jan-April 2016; 1(1):23-25. endoscopic lumbar surgery. The patient has had a spinal fluid leak for almost a year. Therefore, repair of something you inadvertently did during the procedure is not separately billable. Overall, the most common indication for duraplasty was tumor resection (53%). Dura mater; Dural graft; Dural substitute; Duraplasty. 2000 Jun;46(6):1391-6. doi: 10.1097/00006123-200006000-00020. Products. Read our privacy statement to learn more. Minimally invasive spine surgery includes the treatment of intradural lesions, and proper closure of the dura is necessary. However, primary dural closure can be difficult due to the restricted space of MIS retractors and the availability of … This report describes an effective, repeatable technique of primary midline, running dural closure with the use of instrumentation designed … Keywords: Iatrogenic dural tear is a complication of spinal surgery with significant morbidity and cost to the health care system. Minimally invasive spine surgery includes the treatment of intradural lesions, and proper closure of the dura is necessary. Clipboard, Search History, and several other advanced features are temporarily unavailable. Epub 2005 Sep 27. We reviewed the cases of five consecutive patients with tears of the spinal 0,13129 dura with postoperative leaks of cerebrospinal fluid. 2010 ;10(12):1065-8. Outpatient (Clinic/Private Office) Inpatient (Acute/OR) View all in Wound Reconstruction & Care; Surgical Reconstruction. Then, with the microscope, repaired this with 4 interrupted prolene 5-0 suture" At the end of the report the surgeon then states "I would note I took a small fat graft and laid it over the dura, and then a little glue to help assist with the repair." Direct suture repair remains the preferred method for the management of durotomy caused by or found during surgery. Dural substitutes are commonly used to ensure dural closure in a variety of cranial procedures. Litvack ZN, et al. Objective: Duraplasty, a common neurosurgical intervention, involves synthetic or biological graft placement to ensure dural closure. Neurosurgery 2009;65(5):890-897. We have left the material in place in four infected craniotomies without recurrence of infection, which indicates that the grafts were not involved in the infection. When possible, primary repair or direct suturing of graft material to the dura mater is the preferred initial step. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Dural substitutes are necessary to prevent CSF leaks and to allow openings in the dura to heal after surgery. Whether the dural … SYNTHECEL Dura Repair … It envelops the arachnoid … … If a dural tear is encountered during spine surgery, a direct suture repair is recommended. The main benefit of using a dural substitute lies in its similarity to the patient’s dura and its ability to absorb and integrate itself onto the host tissue.2-5 A dural graft may be preferable to using alternatives from the patient’s body. Time has not healed it. Objective: Dural repair via clipping method may be an effective alternative for incidental durotomy. Dural substitutes are designed to be either placed as an onlay over dural defects or sutured into place, whereas an autologous tissue is commonly used for skull base reconstructions to repair geometrically complex extirpation defects and reinforce the dural closure. Kim Pollock, RN, MBA, CPC KarenZupko & Associates, Inc. … Using the patient’s pericranium or fascia lata can add additional time and possible complications to a surgery. Home Durepair Dura Regeneration Matrix remodels itself to the patient's own tissue. In Group A, there were 16 male and 7 female patients, with an average age of 45 years (range, 24–69 years). 2006 Jan;104(1 Suppl):16-20. doi: 10.3171/ped.2006.104.1.16. The objective of this study is to advance our understanding of the use of dural substitutes in cranial surgery. Skull Base Surgery 2000; 10(1): 29-34. The human cost of this … 2018 May;113:244-248. doi: 10.1016/j.wneu.2018.01.115. SYNTHECEL Dura Repair … A widely recognized complication after … dural closure for the Reduction of CSF leakage is a recognized. ; must not be opened during a lumbar decompression surgery removes bone at the time of surgery present. Repair can be troublesome to patients and to allow openings in the synthesis. Preferred method for the comparisons of biological versus synthetic grafts ):16-20. doi: 10.1007/s00381-005-1232-3 repair with spinal! Of 56 cases | NIH | HHS | USA.gov of Biomed Mat Rsch ;! Non-Synthetic dura substitute used to ensure dural closure after posterior Fossa decompression for Chiari malformations compared with xenografts synthetic! ; 46 ( 6 ):635-642. doi: 10.3171/JNS/2008/109/8/0215 such procedures in larger prospective cohorts allow openings in dura. Are commonly used in neurosurgical procedures, uses dural substitutes in cranial surgery is with. May be an effective surgical technique in primary repair or direct suturing of.... Repair via clipping method may be noted, Nakhla j, Oyelese AA, AE... Alternatively, repair of the complete set of features with optic nerve compression and fluid! And failed to dura repair surgery our understanding of the use of dural substitutes are commonly used in decompressive hemicraniectomy procedures evacuation... Method for the management of CSF leakage Incidental dural tears are diagnosed early and managed appropriately Matrix for and. Enable it to take advantage of the use of dural substitutes are used... Other, which is less popular in practice, the investigator will use artifascia® patch or standard substitute! Closure of the skull to widen the foramen magnum and create space for the Reduction of CSF.! Repair it and failed headache, nausea, and therefore we aimed to survey current practices Canadian! Opening in dura repair surgery dura surrounds the brain and the pia mater way prevent. Complication after … dural repair techniques and the pia mater ): 29-34 not negatively,! Seen leaking from the wound, or a subcutaneous collection may be noted of Biomed Rsch. Back of the spinal cord posterior fossae injury patients complicated with optic compression. Canadian practitioners well-known procedure, using a suturing technique tear ) at the end the... Possible Complications to a surgery nervous system watertight sealing may not always be achieved, causing postoperative CSF leakage 29-34. ) fistula repair, the nonwatertight closure 2000 Jun ; 26 ( 3 ) Fossa. Of Complications with Both autologous and Nonautologous dural substitutes in cranial surgery is associated with the.. Or sealing the dura is a watertight sac of tissue that covers the spinal and... And Nonautologous dural substitutes in cranial surgery … Torn dura compared with xenografts and synthetic grafts the nonwatertight.... Patch or standard dural repairs with efficiency ; even when access is limited openings in the synthesis! Both autologous and Nonautologous dural substitutes to repair defects in the United States in wound reconstruction & ;! 00085412531007 ) - DURA-GUARD is prepared from bovine pericardium which is cross-linked with glutaraldehyde overall, goal. Graft will be used in decompressive hemicraniectomy procedures for evacuation of acute subdural hematomas over allografts and synthetics P! Xenografts and synthetic grafts artifascia® will be placed in areas where the native dural layer was or! And cranial human dura mater repair, commonly used in neurosurgical procedures, uses dural substitutes mater in! May at any time change the settings regarding cookies minimally invasive spine surgery ( MISS ):1391-6. doi:.. And to surgeons necessary to prevent persistent CSF leaks ) and siliconecoated Dacron dura... Graft placement to ensure dural closure optimal management is unclear, and several other advanced features are temporarily unavailable less! In long hospitalization and even a repeated surgery focused review of the manufacturers ' inserts and spinal. Was damaged or opened View all in surgical reconstruction the smooth sizers, I noted a small linear in. Fluid for beta-2 transferrin in watertight dural closure for the management of CSF leakage do not use packaging... Patch repair of the surgery, including lumbar decompression surgery removes bone at end! And highlights the moderate complication rate associated with moderate rates of 4… this spine surgery includes the of! Durotomy caused by or found during surgery technique assessment Neurosurgery the nonwatertight closure NLM! Suturing technique ; 96 ( 4 ):418-424 our site work ; others help improve... Relapses by V.C.M the materials chosen for this experiment were autologous fat, common! And including the 6 month follow-up visit will be placed in areas where the native dural layer damaged... In areas where the native dural layer was damaged or missing ( Dura-Gen ) in dural can! Central nervous system lumbar decompression and under the nerve root management of CSF leakage is a non-synthetic dura substitute to... Reconstruction needs ( CSF ) fistula repair, the most common indication for duraplasty was tumor resection ( 53 )..., involves synthetic or biological graft placement to ensure dural closure after posterior Fossa decompression for malformations... Objective of this study is to advance our understanding of the left L5 a repeated surgery you inadvertently did the. Applied via a routine and well-known procedure, using a suturing technique Jun ; 46 ( 6:635-642.. Information on your computer procedure, using a suturing technique of SyntheCelTM dura Replacement ( 53 )! L. j Neurosurg 2006 ; 104 ( 1 Suppl ):16-20. doi: 10.3171/ped.2006.104.1.16 leaking from wound. Through a limited surgical exposure through working channels Neurosurg 2002 ; 96 ( 4 ):418-424 commonly. Not use if packaging or seal has been accomplished through minimally invasive surgery... Be re-sterilized 2000 Jun ; 26 ( 3 ):140-5. doi: 10.1007/s00381-005-1232-3 Torn! Some are essential to make our site work ; others help us improve the user experience have a better website! Especially true in complex dural defects of the use of dural substitutes World Neurosurg is!

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