Krishnan Prasad, Maurya Ved Prakash
Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India.
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Neurosci Rural Pract. 2024 Apr-Jun;15(2):410-413. doi: 10.25259/JNRP_43_2024. Epub 2024 Apr 16.
Post-operative epidural collection is a commonly encountered complication following cranioplasty (CP) in a patient with a sunken skin flap. While on most occasions, the collection is small and resolves spontaneously, on occasion, it may be large enough to warrant evacuation. Further, such collections may predispose to infection and bone flap resorption. Dural hitch sutures were once used routinely in all craniotomies by tacking up the dura at the margins of the craniotomy to the surrounding pericranium to prevent post-operative epidural collection but now several surgeons use them only when deemed absolutely necessary. We describe a variation (in cases where CP is performed in patients with a sunken flap) where several sutures are passed from the neodura through the center of the bone flap (as opposed to the peripherally placed conventional hitch sutures) to obviate the dead space and prevent any post-operative collection.
术后硬膜外积液是颅骨凹陷性皮瓣患者颅骨成形术（CP）后常见的并发症。虽然在大多数情况下，积液量较小且可自行吸收，但有时可能大到需要进行引流。此外，此类积液可能易引发感染和骨瓣吸收。硬膜悬吊缝线曾在所有开颅手术中常规使用，即将硬脑膜在开颅边缘处与周围颅骨膜缝合在一起，以防止术后硬膜外积液，但现在一些外科医生仅在认为绝对必要时才使用。我们描述了一种变通方法（在凹陷皮瓣患者进行颅骨成形术的情况下），即数根缝线从新硬脑膜穿过骨瓣中心（与传统的周边放置的悬吊缝线不同），以消除死腔并防止术后出现任何积液。
