Simplified Dural Reconstruction Procedure Using Biocompatible Polyglycolic Acid Felt with Autologous Abdominal Fat Grafts after a Transpetrosal Approach.

Abstract

OBJECTIVE\nDural reconstruction after transpetrosal approaches is complicated because complete primary closure of presidmoid dura mater is difficult to achieve. To address this problem, we use biocompatible polyglycolic acid (PGA) felt (Durawave) to reconstruct dural defects. To evaluate the use of PGA felt in dural reconstruction, we compared these results with those after conventional duralplasty using autologous fascia grafts.\n\n\nMETHODS\nWe retrospectively surveyed all cases that involved a transpetrosal approach since 2013. In the conventional procedure, autologous fascia was fixed over the dural defect by using stay sutures; any remaining dead space was obliterated by placing abdominal fat grafts. Since April 2017, we have used PGA felt instead of fascia.\n\n\nRESULTS\nOf the 37 cases identified, 27 were reconstructed according to the conventional procedure; the remaining 10 cases were reconstructed by using PGA felt. Among the 27 conventional cases, 8 experienced cerebrospinal fluid (CSF)-related complications, comprising 3 cases of rhinorrhea and 5 cases of subcutaneous fluid collection; 2 cases (7%) required repair surgeries. Of the 10 surgeries involving PGA felt, 1 patient (10%) developed subcutaneous fluid collection and required repair surgery, whereas the remaining 9 cases had no evidence of CSF leakage. In addition, the median dural reconstruction time when using PGA felt was 9 min, which is significantly shorter than when autologous fascia was used (44 min).\n\n\nCONCLUSIONS\nUsing PGA felt for presigmoid dura simplifies dural reconstruction because it obviates the need to suture in a deep field. PGA felt has potential to prevent CSF-related complications after transpetrosal approaches.