Duraplasty: Our Current Experience - 3 go / dental&marketing

Duraplasty Surg Neurol
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COMMENTARY
Caroli et al have presented their massive experience
with Tutoplast pericardial and dural implants
in circumstances where autologous dural substitute
is unavailable, insufficient, or inconvenient.
Their overall results are excellent, and their rare
complications are well reported. Their rationale for
switching from dura to pericardium is reasonable,
despite their previous excellent results.
My only quibble with the authors is the undocumented
assertion in the first sentence of their introduction
that “it is imperative to provide a complete
and watertight dural closure. . .” This
statement places them at one far end of what is
clearly a spectrum of practice, which, at its other
end, includes the plication open of suboccipital decompressions
for Chiari malformations. With the
exception of large defects with underlying denuded
cortex, my routine practice for small defects has
been the placement of gelfoam, and the specifically
nonwatertight Durogen has also proved satisfactory
in our institution. I have long doubted the
possibility of watertight closure without formal
obeisance to the coagulation cascade, which I believe
to be the final arbiter of fistula formation. It is
of interest that in their two cases involving subacute
reoperation, there had been complete reabsorbtion
of the Tutoplast dura and pericardium,
respectively. Perhaps, as suggested, this is only a
reflection of the underlying secondary infections,
but perhaps the closures are not able to maintain
their watertight character as well as might be
thought. All this said, I applaud the efforts of the
authors to prevent scar bridging and CSF fistulae,
am impressed by their results, and appreciate the
sharing of their experience.
C. David Hunt, M.D.
Department of Neurological Surgery
New Jersey Medical School
Newark, New Jersey