Pettorini Benedetta Ludovica, Tamburrini Gianpiero, Massimi Luca, Paternoster Giovanna, Caldarelli Massimo, Di Rocco Concezio
Paediatric Neurosurgery, Catholic University Medical School, Rome, Italy.
Br J Neurosurg. 2010 Feb;24(1):51-4. doi: 10.3109/02688690903386991.
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.
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.
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.
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.
脑脊液漏是神经外科手术常见的并发症，硬脑膜缝合缺陷被认为是最常见的原因。我们报告了在小儿神经外科手术中使用一种新型胶原箔（TissuDura，百特医疗保健股份公司，瑞士）作为硬脑膜替代物的经验。
2004年3月至2007年8月，罗马天主教大学小儿神经外科连续对儿童使用TissuDura。患儿接受幕上、幕下和脊髓区域的手术。在幕上和脊髓手术中，根据覆盖技术使用硬脑膜移植物。在后颅窝手术中，采用衬里技术。
47例患者在手术中使用了TissuDura。31例患者接受后颅窝肿瘤切除术，9例接受幕上肿瘤切除术，7例接受脊髓脊柱裂修补术。在幕上手术中使用TissuDura后未观察到脑脊液漏。脊髓手术后有2例患者发生术后脑脊液漏。这两个手术组均未发现术后脑积水。后颅窝手术后有3例患者发生脑脊液漏。所有3例患者在肿瘤切除前（1例）或肿瘤切除后（2例）均伴有幕上脑室扩张。未观察到与TissuDura直接相关的明显临床不良反应。
TissuDura的主要优点是在特定患者亚组中使用时明显有预防脑脊液漏的能力，且无不良反应或术后感染。
