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Ellis B. Keener

“craniocerebral erosion” 44, 45 has been known and is still known under a wide variety of terms, 46, 53 though its true nature is still not well understood. EXPERIMENTAL WORK In 1923 Sayad and Harvey 51 recorded the first experimental study concerned primarily with the regeneration of the dura mater. In addition to their report, there is an extensive literature on the subject of duraplasty and prevention of meningocerebral adhesions. Interest in the surgical treatment of dural defects arose originally from a desire to prevent the return of meningocerebral adhesions

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J. Fletcher Lee, Guy L. Odom and George T. Tindall

toward two materials, collagen fabric-film laminate † and silicone-coated Dacron, ‡ implanted in the subdural space of dogs. Each product appeared to have favorable physical characteristics, and an experimental evaluation of each material as a potential dural substitute seemed warranted. Silicone-coated Dacron has been used previously for duraplasty, 10 but studies in which the tissue reaction to this material has been evaluated in experimental animals and patients have not been reported. Materials Collagen Fabric-Film Laminate This substance is prepared

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John Mealey Jr., Andrievs J. Dzenitis and Arthur A. Hockey

with marked hypertelorism, a cleft lip and palate, and bifid nose in addition to the obvious cranium bifidum ( Fig. 3 ). A ventriculogram was normal, and a bifrontal craniotomy and duraplasty when he was 4 years old ruled out the presence of anomalous brain tissue in the frontal protrusion but did not produce much cosmetic improvement. Apart from the craniofacial deformity, the patient's growth and development up to age 5 years have seemed normal. Further reconstructive facial surgery and cranioplasty are planned. Fig. 3. A . One-week-old infant with an

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B. Ramamurthi and S. Kalyanaraman

defect will not enlarge further. At this stage the patient comes either with a complaint of a skull defect or with hemiparesis or convulsions. If the defect is fairly small and not inconvenient to the patient, it is our contention that there is no need for surgical therapy. The convulsions can be treated with anticonvulsants. The hemiparesis cannot be improved by surgical methods like cranioplasty or duraplasty. In none of the surgical reports has there been a cure for the hemiparesis or for the smallness of the limbs. In most of the case reports this hemiparesis was

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Joel Bonnal and Jacques Brotchi

I n the management of parasagittal meningiomas, invasion of the superior sagittal sinus is a real challenge. The fear of recurrence and of cerebral edema after excision of a still functioning sinus, and also the danger of injuring a collateral or bridging vein are very real. For this reason, after the total excision of the intrasinus portion of a meningioma, we repair the sinus by a duraplasty 1 and, since 1974, by an autogenous vein graft. Logue 15 recommended using a pericranial graft, Hartmann and Klug 8 a falx dura cuff, and Masuzawa, et al., 16 a

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Herman Hugenholtz and Robert G. Elgie

. Postoperative Management Normal fluid and electrolyte balance was maintained postoperatively, and the preoperative corticosteroids were tapered off unless clinical deterioration due to angiographically proven vasospasm was noted. In this situation, measures additional to corticosteroid therapy and osmotic diuresis were used, including the removal of a bone flap with duraplasty (in three patients) and temporal lobectomy (in two patients). Intracarotid phenoxybenzamine 9 was given without effect in one patient. Analysis of Results Results of management were tabulated

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Ken Winston, Robert M. Beatty and Edwin G. Fischer

. The dural repair can usually be accomplished with a graft of pericranium but may require fascia lata or lyophylized dura. Contrary to the way Stein and Tenner 25 managed one of their children with an expanding fracture (their Case 1), we believe that it is probably never necessary to resect the herniated brain, even if it looks grossly abnormal. If the cerebral hernia is large, then duraplasty may be necessary (see details of our Case 1) so that the hernia can be reduced without being compressed excessively or stretched over sharp dural ridges. The defect in bone

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Repair of spinal dural defects

An experimental study

Jeffrey T. Keller, Carlos M. Ongkiko Jr., Mary C. Saunders, Frank H. Mayfield and Stewart B. Dunsker

, 12, 13 thin rubber tissue, 1, 2 platinum foil, 40 and silver foil 50 had been implanted in areas of the cortex in an attempt to reduce cicatrix formation between the cortex and meninges. Although the list of materials for duraplasty continues to expand, no one substance (either organic, inorganic, metallic, synthetic, or any miscellaneous material) has received universal acceptance ( Table 1 ). TABLE 1 Materials used by different authors as dural substitutes Significant observations were made during the first half of the 20th century regarding

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Carlos M. Ongkiko Jr., Jeffrey T. Keller, Frank H. Mayfield and Stewart B. Dunsker

O f the materials in use today for duraplasty, 5 silicone-coated Dacron has gained wide acceptance. Lee, et al. , 6 recommended silicone-coated Dacron as an ideal substitute for dura because of minimal tissue reactions in animal studies. In 50 craniotomy cases, Collis and Meier 3 found little, if any, foreign-body reactions with its use. On the other hand, silicone-coated Dacron is the only synthetic material used clinically that has been reported in the literature to be associated with an unusual complication. 1, 2 In our experimental studies on spinal

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Jean Paul Constans, Jean François Meder, Enrico De Divitiis, Renato Donzelli and Francesco Maiuri

wall was then opened widely and the amorphous cheesy material within was removed. The cyst was the size of a tennis ball. Although the capsule was removed it was not possible to dissect the inner membrane of the cyst from the dura mater. Therefore, the dura, which was markedly thickened and contained many small calcifications, was removed. The cerebral cortex in the anterior temporal and Sylvian regions was found to be compressed and very atrophic. A duraplasty with amnion was then performed. Pathological Examination Histological examination of the wall of