Rai Survendra Kumar R, Dandpat Saswat K, Jadhav Dikpal, Bhambere Sagar, Bhatia Kushal, Gajbhiye Nikhil K, Goel Atul H
Department of Neurosurgery, K. E. M. Hospital & Seth G. S. M, C., Parel, Mumbai, Maharashtra, India.
Neurol India. 2025 Jan 1;73(1):133-137. doi: 10.4103/neuroindia.NI_798_20. Epub 2025 Feb 7.
Quest for finding ideal graft material for covering dural defect continues. Dura mater (DM)/pachymeninges consists of two layers; hence possibility of splitting this layer has been explored.
Microsurgical splitting of dura into two layers for covering the dural defect.
Splitting of DM with number 15 surgical blade was carried out on ten cadavers. Splitting the dura into two distinct layers was possible in every specimen paving way for implementing in routine neurosurgical practice. This technique was implemented in covering accidental dural defects in seven cases with defects ranging from 1 cm to 3.5 cm. All cases were followed up for potential complications in the long run.
Harvesting autologous dural graft by splitting it into two layers was possible with number 15 scalpel in autopsy specimen and routine neurosurgical practice. All dural defects were repaired without any complication with follow-up of more than 1 year.
Best replacement of dural defect is by dura itself. The technique of harvesting autologous dura by splitting into two layers is easy, inexpensive, and devoid of all graft-related complications found till date. Splitting of dura is technically demanding but possible in small- to medium-sized dural defects. This technique has inherent limitations arising due to the amount of surrounding dura available depending on the size of craniotomy and the size of the dural defect. This procedure cannot become a substitute for cases requiring the extensive sacrifice of the dura, especially during meningioma surgery. This technique emphasis value of good microsurgical techniques.
寻找用于覆盖硬脑膜缺损的理想移植材料的探索仍在继续。硬脑膜由两层组成，因此人们探索了将这层膜分开的可能性。
通过显微手术将硬脑膜分成两层以覆盖硬脑膜缺损。
在十具尸体上用15号手术刀片对硬脑膜进行分离。每个标本都能将硬脑膜分成两个不同的层，为在常规神经外科手术中应用铺平了道路。该技术应用于7例意外硬脑膜缺损的覆盖，缺损范围为1厘米至3.5厘米。所有病例均进行了长期潜在并发症的随访。
在尸检标本和常规神经外科手术中，用15号手术刀将自体硬脑膜分成两层获取硬脑膜移植物是可行的。所有硬脑膜缺损均得到修复，无一例并发症，随访时间超过1年。
硬脑膜缺损的最佳替代物是硬脑膜本身。将自体硬脑膜分成两层获取的技术简单、廉价，且迄今未发现与移植物相关的并发症。硬脑膜的分离在技术上要求较高，但在中小型硬脑膜缺损中是可行的。由于根据开颅手术的大小和硬脑膜缺损的大小，周围硬脑膜的数量有限，该技术存在固有的局限性。对于需要大量牺牲硬脑膜的病例，尤其是在脑膜瘤手术期间，该手术不能替代。该技术强调了良好显微手术技术的价值。
