雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 48, Issue 10 （October 2020）

Neurological Surgery 脳神経外科 48巻10号（2020年10月発行）

Japanese English

テクニカル・ノート

広範囲に硬膜欠損が生じた開頭手術におけるDuraGen^®に対する硬膜外吊り上げ手技の“TIPS” Technical “Tips” for Epidural Tenting Using DuraGen^® for Surgical Management of Large Dural Defects:A Technical Note 中山陽介 ¹ , 田中俊英 ¹ , 勅使川原明彦 ¹ , 野上諒 ¹ , 舘林太郎 ¹ , 府賀道康 ¹ , 栃木悟 ¹ , 長谷川譲 ¹ , 村山雄一 ² Yosuke NAKAYAMA ¹ , Toshihide TANAKA ¹ , Akihiko TESHIGAWARA ¹ , Ryo NOGAMI ¹ , Rintaro TACHI ¹ , Michiyasu FUGA ¹ , Satoru TOCHIGI ¹ , Yuzuru HASEGAWA ¹ , Yuichi MURAYAMA ² ¹東京慈恵会医科大学附属柏病院脳神経外科 ²東京慈恵会医科大学脳神経外科 ¹Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital ²Department of Neurosurgery, Jikei University School of Medicine キーワード： DuraGen^® , epidural tenting , duralplasty , tumor resection Keyword: DuraGen^® , epidural tenting , duralplasty , tumor resection pp.903-907

発行日 2020年10月10日 Published Date 2020/10/10

DOI https://doi.org/10.11477/mf.1436204294

PDF(2258KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

Ⅰ．はじめに

　吸収性コラーゲン人工硬膜（DuraGen^®, Integra Lifescience, New Jersey, USA）は開頭手術において硬膜補塡材料として使用されており^1-4)，日本でも2019年7月から使用可能となった．しかし硬膜欠損部が広い場合，DuraGen^®に直接硬膜外吊り上げを施すことができないため，術後硬膜外液貯留が問題となることが報告されている．今回われわれは，DuraGen^®に対する硬膜外吊り上げ手技を紹介する．

　DuraGen^®, an absorbable, engineered collagen-based artificial graft was introduced in Japan in September 2019 for cranial, transsphenoidal, and spinal surgeries. In addition to its efficacy and safety profile, owing to sutureless dural repair, DuraGen^® is widely accepted by neurosurgeons. Direct tenting with DuraGen^® is occasionally required in patients with large dural defects, particularly in cases of tumors adherent to the dura. To overcome this limitation, we introduced a surgical technique for epidural tenting using DuraGen^®.

　A 78-year-old man with a history of alexia underwent craniotomy for resection of a left temporal lobe metastatic tumor. We completely removed the recurrent tumor, which was strongly adherent to the dura in the middle cranial fossa. A layer of DuraGen^® was used as a subdural underlay beneath the autologous dura to close the wide dural defect. To avoid postoperative epidural fluid collection, we retracted the DuraGen^® from the epidural aspect and interposed several pieces of muscle, which were sutured on the subdural aspect to ensure that the muscle pieces securely plugged the dural defect. We placed an additional overlay of DuraGen^® along the autologous dura. The patient's postoperative course was uneventful without cerebrospinal fluid leakage, tension pneumocephalus, or wound infection. Reoperations for tumor resection, particularly surgical procedures for refractory meningiomas and malignant tumors cause increasing fragility and wide defects of the dura. DuraGen^® placement enables sutureless closure and is less time-consuming. Our technique of epidural direct tenting with DuraGen^® using muscle pieces sutured on the subdural aspect could be useful in patients with significantly large dural defects and can prevent postoperative epidural fluid collection to ensure complete dural sealing.