Analysis of Decompressive Craniectomies with Subsequent Cranioplasties in the Presence of Collagen Matrix Dural Substitute and Polytetrafluoroethylene as an Adhesion Preventative Material.

Abstract

Decompressive craniectomy is an established treatment for malignant intracranial hypertension. Cranioplasty is performed once cerebral swelling has resolved. Complications include infection, postoperative fluid collections, hematoma, reoperation, and seizures. Our experience using a double layer technique during craniectomy with a collagen matrix onlay dural substitute and expanded polytetrafluoroethylene for antiadhesive properties during cranioplasty was reviewed. This is a retrospective chart review of 39 consecutive patients who underwent craniectomy with placement of collagen matrix dural onlay and expanded polytetrafluoroethylene and subsequent cranioplasty. Demographic data, size of craniectomy defect, estimated blood loss, operative time, time between operations, presence of dural tackups, and postoperative complications were analyzed. Mean operative time was 132 minutes and estimated blood loss was 112 mL. Overall complication rate was 25.6% and no mortality was encountered. Nine patients had postoperative fluid collections measuring ≥ 10 mm in thickness and/or 5 mm of midline shift. Two patients required reoperation for these collections. Two patients developed infections requiring bone flap removal. Three patients developed seizures after cranioplasty. Five patients required shunt placement for hydrocephalus. Our dual layer closure technique at time of decompressive craniectomy carries a similar reduction in operative time and estimated blood loss when compared with cranioplasty series with other antiadhesives present. The technique described enables easy dissection of the musculocutaneous flap from the dural plane during cranioplasty and increases the safety of the operation.