Abstract
Introduction
Young children with significant ventricular dilatation or large intracranial fluid spaces often have a very thin cortical mantle as a result of persistently raised intracranial pressure. This rim of cortex has a tendency to fall away from the dura into the cavity during and after intracranial surgery, due to the lack of support, once the pressure in the fluid cavity has been reduced. This can lead to tearing of cortical bridging veins and the formation of post-operative subdural haematomas.
Methods
We describe a simple technique that attempts to prevent this phenomenon occurring using tissue glue. Once the craniotomy has been performed and the dura has been formally opened, tissue glue is applied to the underside of the dura around the edge of the wound, prior to corticotomy.
Results and conclusion
This results in the cortical mantle adhering to the undersurface of the dura and prevents the mantle from falling into the cavity either during the procedure or post-operatively.
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Comment
We have all experienced the sometimes devastating consequences of cortical collapse and subdural effusions after the exhilarating resection of a lesion deep within the brain. This is a very simple and elegant technical note to prevent the collapse of a (thin) cortical mantle after ventricular, or deep, surgery. It is only a minor modification of previous reports also aiming to prevent CSF leak from the intraventricular to the subdural space, and it is only a report of one case, but this seems very feasible for thick cortical mantle, too. There is no reason why this technique shouldn’t work in adults, too. The authors are to be encouraged to build a case series and report on those results in the future.
W. Peter Vandertop
The Netherlands
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Leach, P.A., Howarth, S.P.S., Grigorakou, MA. et al. Use of tissue glue to prevent collapse of the cortical mantle during and after cranial surgery in children: a technical note. Acta Neurochir 152, 893–895 (2010). https://doi.org/10.1007/s00701-009-0349-7
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DOI: https://doi.org/10.1007/s00701-009-0349-7