Takashi Tsuruno

Efficacy of arachnoid plasty with collagen sheets and fibrin glue: An in vitro experiment and a case review.

Background: Postoperative subdural fluid collection sometimes occurs after clipping of cerebral aneurysms. Arachnoid plasty is used to prevent such postoperative complications; however, the optimal materials for arachnoid plasty remain unclear. In this study, we aimed to clarify the optimal materials for arachnoid plasty and report our experience of arachnoid plasty after clipping of unruptured aneurysms. Methods: In an in vitro experiment, adhesive strengths of three materials permitted for use in the intradural space, such as collagen sheets, gelatin sponge, and oxidized cellulose sheets, were measured by assessing their water pressure resistance. Then, 80 consecutive cases surgically treated unruptured cerebral aneurysms were retrospectively reviewed to examine the occurrence rate of postoperative subdural fluid collection. Results: The collagen sheet exhibited the greatest adhesive strength, so we used collagen sheets for the arachnoid plasty procedures. In all of these cases, arachnoid plasty was performed with fibrin glue-soaked collagen sheets. No postoperative subdural fluid collection, inflammation, or allergic reactions occurred in any case. Conclusions: The present study suggests that collagen sheet might be one of the optimal materials for arachnoid plasty. This technique is simple and may be effective to prevent subdural fluid collection after clipping.

Craniotomy repair with titanium miniplates

Craniotomy repair with newly designed titanium miniplates is described. The miniplates, made of malleable titanium, include burr hole covers and kerf covers for use over the craniotomy line. The plates are easily contoured by hand and have been successfully placed in 39 cases with no incidence of infection and no cosmetic problems.