Study on the effect of modified subdural patch with intermittent suture on prevention of complications after supratentorial craniotomy

doi:10.3877/cma.j.issn.2095-9141.2019.05.005

Abstract

Abstract:

Objective

To investigate the incidence of related complications after different surgical types to repair dural defects during supratentorial craniocerebral operation, and to discuss which surgical types has the most advantages in clinical application.

Methods

A total of 135 cases (Supratentorial Craniotomy operated by the same surgeon) were enrolled retrospectively from May 2018 to May 2019. According to the performed surgical type, the 135 cases were divided into experimental and control group. The experimental group (71 cases) was repaired by modified interrupted suture with patch, the control group (64 cases) was repaired by continuous suture with autologous periosteum or galea aponeurotica. We compared the consuming time of repair, postoperative drainage volume 24 h after operation, and the incidence of complications such as postoperative epilepsy, epidural effusion and subcutaneous hydrops, and the statistical analysis was carried out to the related index.

Results

The average consuming time of experimental group was significantly shorter than that of control group (experimental group: 12 min; control group: 25 min), the average epidural drainage volume in the experimental group (278 mL) was higher than that in the control group (245 mL) at 24 h after operation. Among the experimental group, 1 case (1.41%) had subcutaneous hydrops, which was significantly lower than control group (10.94%). The incidence of postoperative epilepsy within 3 months in control group was significantly higher than experimental group (experimental group: 2.82%; control group: 14.06%), the difference is statistically significant (P<0.05). The incidence of postoperative epidural effusion in the experimental group(5.63%) was higher than that in the control group (4.69%), but no statistical significance was found (P>0.05). There was no special treatment to 7 epidural effusion cases without clinical symotoms, waiting for it to absorb on its own. All 8 cases of subcutaneous hydrops were cured by lumbar cistern drainage. Ten patients developed epileptic seizures 3 months after operation. Symptoms were controlled after regular antiepileptic treatment and were followed up.

Conclusion

Modified interrupted suture with patch can be used in kinds of dural defects during supratentorial craniocerebral operation, it has obvious advantages in shortening operation time, preventing related complications including subcutaneous hydrops and postoperative epilepsy, and is worthy of clinical promotion.

Key words: Supratentorial craniocerebral operation, Repair dural, Patch, Epilepsy, Subcutaneous hydrops, Interrupted suture

Hao Wu, Yunlei Li, Mijiti Maimaitili·, Dangmurenjiafu Geng·, Muerzhati Mamutijiang·, Liexing Chen, Gonggaoang Bate·, Guohua Zhu. Study on the effect of modified subdural patch with intermittent suture on prevention of complications after supratentorial craniotomy[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2019, 05(05): 276-279.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsjcswkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9141.2019.05.005

https://zhsjcswkdzzz.cma-cmc.com.cn/EN/Y2019/V05/I05/276

Figures/Tables 2

References 15

[1]	宋毅,刘明冬,崔坤篪,等.生物型硬膜修补材料在防治颅脑创伤术后硬膜下积液中的应用[J].创伤外科杂志, 2011, 13(5): 451.
[2]	Conger A,Zhao F,Wang X, et al. Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: trends in repair failure and meningitis rates in 509 patients[J]. J Neurosurg, 2018, 130(3): 861-875.
[3]	Fraser S,Gardner PA,Koutourousiou M, et al. Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery[J]. J Neurosurg, 2018, 128(4): 1066-1071.
[4]	王和功,杨慧东,郑华煜,等.补丁法修补硬膜预防术后脑脊液漏的临床应用[J].中国微侵袭神经外科杂志, 2016, 21(1): 34-35.
[5]	Patrascu E,Manea C,Sarafoleanu C. Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options[J]. Rom J Rhinol, 2017, 7(27): 143-151.
[6]	惠鲁生,蔡用武,樊宪义,等.粉碎性颅底骨折后CCF合并脑脊液漏的治疗策略[J].中华神经外科疾病研究杂志, 2015, 14(3): 247-250.
[7]	史志东,郭英,王昆,等.新型人工硬脑膜和自体膜的对比实验研究[J].中华神经医学杂志, 2013, 12(23): 99-101.
[8]	Nelson RF,Roche JP,Gantz BJ, et al. Middle Cranial Fossa (MCF) approach without thuse of lumbar drain for the management of spontaneous cerebral spinal fluid (CSF) leaks[J]. Otol Neurotol, 2016, 37(10): 1625-1629.
[9]	Chaaban MR,Illing E,Riley KO, et al. Spontaneous cerebrospinal fluid leak repair: a five-year prospective evaluation[J]. Laryngoscope, 2014, 124(1): 70-75.
[10]	肖新如,吴震,张力伟,等.颅前窝内外沟通性肿瘤切除术后的颅底重建[J].中国微侵袭神经外科杂志, 2009, 14(12): 529-532.
[11]	陈瑶刚,赵明媚,宁铁英,等.人工脑膜在急诊颅脑手术中的应用价值[J].河北医学, 2010, 16(6): 688-689.
[12]	Yamada K,Miyamoto S,Takayama M, et al. Clinical application of a new bioabsorbable artificial dura mater[J]. J Neurosurg, 2002, 96(4): 731-735.
[13]	张念平,付振,王元飞,等.硬脑膜修补材料在神经外科手术中的应用[J].中国医学创新, 2010, 7(2): 129-131.
[14]	于书卿,赵继宗,孟国路,等.胶原海绵人工脑膜临床应用研究[J].中华神经外科疾病研究杂志, 2003, 2(4): 354.
[15]	Barth M,Tuettenberg J,Thomé C, et al. Watertight dural closure: is it necessary? A prospective randomized trial in patients with supratentorial craniotomies[J]. Neurosurgery, 2008, 63(4 Suppl 2): 352-358.

组别	例数	术中修	术后24 h平均引流量(mL)	并发症发生率[例(%)]
组别	例数	补平均耗时(min)	术后24 h平均引流量(mL)	硬膜外积液	皮下积液	癫痫发作（术后3个月内）
实验组	71	12	278	4(5.63)	1(1.41)	2(2.82)
对照组	64	25	245	3(4.69)	7(10.94)	9(14.06)
t/χ²值	?	29.046	15.201	0.020	3.906	5.689
P值	?	0.001	0.001	0.888	0.048	0.017

组别	例数	术中修	术后24 h平均引流量(mL)	并发症发生率[例(%)]
组别	例数	补平均耗时(min)	术后24 h平均引流量(mL)	硬膜外积液	皮下积液	癫痫发作（术后3个月内）
实验组	71	12	278	4(5.63)	1(1.41)	2(2.82)
对照组	64	25	245	3(4.69)	7(10.94)	9(14.06)
t/χ²值	?	29.046	15.201	0.020	3.906	5.689
P值	?	0.001	0.001	0.888	0.048	0.017

Please choose a citation manager

Content to export