Use of polytetrafluoroethylene dural substitute as adhesion preventive material during craniectomies.

OBJECTIVE: We describe the use of an artificial dural substitute in order to prevent peridural fibrosis in patients who underwent craniectomy and subsequent cranioplasty. PATIENTS AND METHODS: In our institution we performed decompressive craniectomy and subsequent cranioplasty, with autologous bone flap, in 52 patients (mean age 32 years) between 1998 and 2004. Most of the craniectomy procedures were performed as emergency, brain swelling relief, measure for various reasons. The standard decompressive craniectomy technique that we perform includes bone removal, meningoplasty and protection from future adhesion formations in 23 of the 52 patients by the use of polytetrafluoroethylene (ePTFE) dural substitute (Preclude((R))). The substitute was applied over dural anasynthesis and under the galea, during craniectomy. The development of adhesion formations between tissue layers was evaluated during reoperation for cranioplasty.
RESULTS: During cranioplasty reoperation we observed that the polytetrafluoroethylene dural substitute succeeds in creating a controlled dissection plane, facilitating access to the epidural space, shortening the operation time by approximately 25% and diminishes the intraoperative blood loss by 37% as compared with the group of patients underwent standard cranioplasty. The difference is of statistical significance (p<0.005). As a result, the use of polytetrafluoroethylene dural substitute as adhesion preventive material could make the cranioplasty operation safer and more successful.
CONCLUSION: Polytetrafluoroethylene dural substitute is able to prevent peridural scarring and is very efficient in facilitating cranioplasty in patients who underwent craniectomy regardless the indication.