Spellicy Samantha E, Kilianski Joseph R, Poston Rachel, Moore-Hill Debra, Vale Fernando L
Departments of Neurosurgery and.
Neurology.
J Neurosurg Case Lessons. 2021 Jun 14;1(24):CASE21183. doi: 10.3171/CASE21183.
Surgical meshes have found widespread use in neurosurgical practice. While commonly recognized risks of synthetic mesh include infection, exposure of mesh implants, and foreign body reaction, the risk of mesh tethering to neural structures is often overlooked.
The authors presented the first case, to their knowledge, of the disentanglement of mesh interfaced to cortical tissue. The patient, a 68-year-old woman, presented with severe intractable seizure disorder and worsening left hand function and incoordination after meningioma resection and cranioplasty 9 years earlier. Magnetic resonance imaging (MRI) demonstrated interval progression of macrocystic encephalomalacia involving the right supplementary motor area, with fluid-attenuated inversion recovery signal extending posteriorly into the right primary motor cortex. Both computed tomography and MRI suggested potential tethering of the cortex to the overlying cranioplasty mesh. Because of the progressive nature of her condition, the decision was made to surgically remove the tethered mesh.
De-tethering brain parenchyma from surgical mesh requires careful microdissection and judicious use of electrocautery to minimize further tissue damage and preserve neurological function. This inadvertent complication evinces the importance of using dural substitutes when unable to primarily repair the dura to prevent scarring and tethering of neural tissues to synthetic cranioplasty materials.
外科补片在神经外科手术中已得到广泛应用。虽然合成补片常见的风险包括感染、补片植入物暴露和异物反应，但补片与神经结构相连的风险常常被忽视。
据作者所知，他们报告了首例与皮质组织相连的补片松解病例。该患者为一名68岁女性，9年前因脑膜瘤切除和颅骨成形术后出现严重难治性癫痫发作、左手功能恶化和运动不协调。磁共振成像（MRI）显示累及右侧辅助运动区的大囊性脑软化有进展，液体衰减反转恢复信号向后延伸至右侧初级运动皮层。计算机断层扫描和MRI均提示皮质可能与覆盖的颅骨成形补片相连。由于病情呈进行性发展，决定手术切除相连的补片。
将脑实质与外科补片松解需要仔细的显微解剖，并谨慎使用电灼，以尽量减少进一步的组织损伤并保留神经功能。这种意外并发症表明，在无法一期修复硬脑膜时使用硬脑膜替代物以防止神经组织与合成颅骨成形材料形成瘢痕和相连的重要性。
