====== Dural Dissection ====== '''Dural dissection''' refers to the surgical technique of incising and separating the layers of the dura mater to expose underlying neural or vascular structures. === Definition === **Dural dissection** is the controlled separation or incision of the dura mater, the outermost meningeal layer, often required in neurosurgical procedures for access to the brain, spinal cord, or dural-based lesions. === Anatomical Context === * The **dura mater** consists of two layers: - **Periosteal layer** (outer): adheres to the skull. - **Meningeal layer** (inner): continues into the spinal canal. * In the spine, the dura is a single layer. === Surgical Applications === * **Craniotomy**: Opening of the dura to access the cortex or deeper structures. * **Spine surgery**: Dural opening to access the spinal cord or intradural lesions. * **Dural-based tumors**: e.g., meningiomas, where dural dissection helps define margins or perform resection. * **Bypass and aneurysm surgery**: Dissection around dural folds (e.g., tentorium, falx). === Techniques === * Performed under magnification (microscope or loupe). * Linear, curvilinear, or stellate incisions using micro scissors or scalpel. * Edge of dura often reflected and secured with tack-up sutures to reduce epidural bleeding. * Dural closure with watertight sutures or dural substitutes to prevent CSF leak. === Risks === * **Cerebrospinal fluid (CSF) leak** * **Dural venous sinus injury** * **Postoperative pseudomeningocele or meningitis** if not properly closed === Notes === * In some cases (e.g., Chiari malformation surgery), duraplasty is performed after dural dissection to enlarge the dural space. * Dural dissection can be technically challenging near adhesions, scar tissue, or vascular structures.