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            1 => "Dural closure"
            2 => "Dural substitutes"
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            1 => "Cirug&#237;a de fosa posterior"
            2 => "Duramadre"
            3 => "F&#237;stulas de LCR"
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        "titulo" => "Summary"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#46; Dural defects and cerebrospinal fluid &#40;CSF&#41; leaks are a common problem following posterior fossa surgery&#46; The management includes either nonoperative management &#40;e&#46;g&#46; external lumbar drainage&#41; or surgical re-exploration&#46;</p> <span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present our surgical&#44; clinical and histopathological experience of dural closure in the posterior fossa&#46; In order to avoid CSF leaks we developed a simple but effective and time-sparing method using a well-cut sheet of a vicryl-poly-pdioxanone mesh &#40;Ethisorb &#174;&#41; covering the whole defect of the craniectomy&#46; Additional fibrin glue or sealant is not necessary&#46; Special attention was focused upon the frequency of postoperative complications&#44; in particular infection rate and CSF leaks&#46;</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">85 patients were treated with vicryl mesh as dural substitute after posterior fossa surgery due to distinct pathologies&#46; An illustrative case is presented&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In none of the patients a postoperative infection was observed&#46; Four patients presented postoperative CSF leakage and were treated by percutaneous lumbar drainage&#46; Three of the patients improved completely&#44; requiring no additional treatment&#46; Only in one case defect covered by a vicryl mesh&#44; a surgical reexploration became necessary&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We consider the vicryl mesh &#40;Ethisorb &#174;&#41; as an ideal dural substitute especially for the dural closure of the posterior fossa&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los defectos en el cierre de duramadre y por consiguiente f&#237;stulas de l&#237;quido cefalorraqu&#237;deo son comunes en cirug&#237;a de fosa posterior&#46; El tratamiento incluye manejo conservador o no quir&#250;rgico como drenaje lumbar externo de l&#237;quido cefalorraqu&#237;deo&#44; cuando &#233;stas medidas fallan se requiere de una nueva cirug&#237;a&#46;</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Con el prop&#243;sito de evitar f&#237;stulas de l&#237;quido cefalorraqu&#237;deo en cirug&#237;a de fosa posterior desarrollamos un m&#233;todo simple&#44; pero efectivo&#44; que permite ahorrar tiempo quir&#250;rgico utilizando una malla de viyril-poly-p-dioxanone &#40;Ethisorb&#174;&#41; para cubrir por completo el defecto de la craniectom&#237;a&#46; No se requiere del uso adicional de adhesivo de fibrina&#46; Nuestra experiencia cl&#237;nica&#44; quir&#250;rgica y hallazgos histopatol&#243;gicos con &#233;sta t&#233;cnica de cierre dural se discuten en el presente art&#237;culo as&#237; como las complicaciones&#44; en particular infecci&#243;n y presencia de f&#237;stulas de l&#237;quido cefalorraqu&#237;deo&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En 85 pacientes sometidos a cirug&#237;a de fosa posterior debida a diferentes patolog&#237;as&#44; se utiliz&#243; una malla de vicryl &#40;Ethisorb&#174;&#41; como sustituto de duramadre&#46; Se presenta un caso que ilustra nuestra t&#233;cnica&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En ninguno de los casos se present&#243; infecci&#243;n postoperatoria&#46; Cuatro casos presentaron f&#237;stula de l&#237;quido cefalorraqu&#237;deo y fueron tratados con drenaje lumbar externo&#59; tres pacientes mejoraron por completo sin requerir otras medidas&#46; S&#243;lo en un caso se requiri&#243; de exploraci&#243;n quir&#250;rgica&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">De acuerdo con los resultados y complicaciones&#44; consideramos que la malla de vicryl &#40;Ethisorb&#174;&#41; es un sustituto de duramadre ideal&#44; en particular para cirug&#237;as de fosa posterior&#46;</p>"
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Vol. 17. Núm. 6.
Páginas 527-531 (enero 2005)
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Vol. 17. Núm. 6.
Páginas 527-531 (enero 2005)
Time sparing and effective procedure for dural closure in the posterior fossa using a vicryl mesh (Ethisorb®)
Cierre de duramadre en cirugía de fosa posterior con una malla de vicryl (Ethisorb®): un procedimiento simple y efectivo
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I. Reyes-Moreno, R. Verheggen
Department of Neurosurgery. University Hospital and School of Medicine. Gottingen. Germany
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Información del artículo
Summary
Introduction

. Dural defects and cerebrospinal fluid (CSF) leaks are a common problem following posterior fossa surgery. The management includes either nonoperative management (e.g. external lumbar drainage) or surgical re-exploration.

Objectives

We present our surgical, clinical and histopathological experience of dural closure in the posterior fossa. In order to avoid CSF leaks we developed a simple but effective and time-sparing method using a well-cut sheet of a vicryl-poly-pdioxanone mesh (Ethisorb ®) covering the whole defect of the craniectomy. Additional fibrin glue or sealant is not necessary. Special attention was focused upon the frequency of postoperative complications, in particular infection rate and CSF leaks.

Patients

85 patients were treated with vicryl mesh as dural substitute after posterior fossa surgery due to distinct pathologies. An illustrative case is presented.

Results

In none of the patients a postoperative infection was observed. Four patients presented postoperative CSF leakage and were treated by percutaneous lumbar drainage. Three of the patients improved completely, requiring no additional treatment. Only in one case defect covered by a vicryl mesh, a surgical reexploration became necessary.

Conclusion

We consider the vicryl mesh (Ethisorb ®) as an ideal dural substitute especially for the dural closure of the posterior fossa.

Key words:
CSF leaks
Dural closure
Dural substitutes
Posterior fossa surgery
Vicryl mesh
Abreviaturas:
CSF
LCR
Resumen
Introducción

Los defectos en el cierre de duramadre y por consiguiente fístulas de líquido cefalorraquídeo son comunes en cirugía de fosa posterior. El tratamiento incluye manejo conservador o no quirúrgico como drenaje lumbar externo de líquido cefalorraquídeo, cuando éstas medidas fallan se requiere de una nueva cirugía.

Objetivos

Con el propósito de evitar fístulas de líquido cefalorraquídeo en cirugía de fosa posterior desarrollamos un método simple, pero efectivo, que permite ahorrar tiempo quirúrgico utilizando una malla de viyril-poly-p-dioxanone (Ethisorb®) para cubrir por completo el defecto de la craniectomía. No se requiere del uso adicional de adhesivo de fibrina. Nuestra experiencia clínica, quirúrgica y hallazgos histopatológicos con ésta técnica de cierre dural se discuten en el presente artículo así como las complicaciones, en particular infección y presencia de fístulas de líquido cefalorraquídeo.

Pacientes

En 85 pacientes sometidos a cirugía de fosa posterior debida a diferentes patologías, se utilizó una malla de vicryl (Ethisorb®) como sustituto de duramadre. Se presenta un caso que ilustra nuestra técnica.

Resultados

En ninguno de los casos se presentó infección postoperatoria. Cuatro casos presentaron fístula de líquido cefalorraquídeo y fueron tratados con drenaje lumbar externo; tres pacientes mejoraron por completo sin requerir otras medidas. Sólo en un caso se requirió de exploración quirúrgica.

Conclusiones

De acuerdo con los resultados y complicaciones, consideramos que la malla de vicryl (Ethisorb®) es un sustituto de duramadre ideal, en particular para cirugías de fosa posterior.

Palabras clave:
Cierre dural
Cirugía de fosa posterior
Duramadre
Fístulas de LCR
Malla de vicryl

Artículo

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