Dural closure [Neurosurgery Wiki]

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====== Dural closure ======

[[Water-tight dural closure]] is imperative after [[neurosurgical procedure]]s because inadequately treated [[leakage]] of cerebrospinal fluid (CSF) can have serious consequences. 

===== Types =====

A variety of techniques for [[dural closure]] have been described, employing natural and artificial materials. 

[[Water-tight dural closure]].

Water-tight with additional muscle patch/ not Water-tight with small or large defect (>1 cm) remaining).



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When such a task cannot be performed, [[dural substitute]] and other adjunctive measures can provide an effective barrier between the subarachnoid compartment and the extradural space.

A novel technique for dural reconstruction involves [[soft tissue]] grafts in the form of fibrous or fibromuscular flaps, which are placed on the dural defects to seal the gaps. These soft tissue grafts represent an appropriate [[scaffold]] for cell ingrowth and [[fibrosis]], thus preventing CSF. In a pilot study, Velnar and Gradisink described the application of soft tissue grafts for dural reconstruction in 10 patients who underwent convexity meningioma surgery
((Velnar T, Gradisnik L. Soft tissue grafts for dural reconstruction after
meningioma surgery. Bosn J Basic Med Sci. 2019 Mar 11. doi:
10.17305/bjbms.2019.3949. [Epub ahead of print] PubMed PMID: 30877836.
)).

===== Dural substitute =====

see [[Dural substitute]].

===== Dural sealant =====

see [[Dural sealant]].

===== Inlay-onlay dural repair technique =====
[[Inlay-onlay dural repair technique]]