硬膜下水腫の予防としてのくも膜閉鎖法の提唱 : 人工硬膜のseal手技「Mesh and Glue法」の新しい応用

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概要

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• Expanded polytetrafluoroethylene (ePTFE) has been widely used as a dura substitute since the use of cadaveric dura mater was prohibited because of the possibility of transmission of Creutzfeldt-Jakob disease. This material, however, is often associated with the leakage of cerebrospinal fluid. We have recently developed a method of sealing the suture line with absorbable mesh and fibrin glue. This method, named mesh-and-glue technique, proved to be extremely effective to prevent CSF leakage based on the clinical results and on basic experiments. On the other hand, subdural hygroma after craniotomy, which can be regarded as a CSF collection through the arachnoid tear, has sometimes become a serious complication requiring surgical extirpation. Hence, we have tried to apply the mesh-and-glue technique to seal the arachnoid tear. In the conventional wound closure, the dissected arachnoid membrane is left alone. After the dura mater is closed water-tightly, normal saline is usually injected to prevent postoperative tension pneumocephalus. It is worth noting that the injected normal saline locates in subdural space, not the subarachnoid space. If the dissected arachnoid membrane adheres incompletely to form a one-way valve, the subarachnoid space will then be enlarged. Thus, the water-tight closure of the arachnoid membrane must be effective to prevent the postoperative subdural hygroma. The mesh-and-glue technique would be a useful tool for this purpose. In our new closure method, the dissected arachnoid membrane is sealed with the mesh-and-glue technique after the intracranial surgical manuver. Thereafter, the normal saline is injected into subarachoid space, reestablishing normal tension in the slack brain. Then the dura mater is closed watertightly without injecting the saline into the subdural space. We have applied this closure method in a small number of craniotomies, mainly for non-ruptured middle cerebral or internal carotid aneurysms, and no subdural hygroma was encountered. Of course, several diseases require wide opening of the arachnoid membrane, which make it difficult to close the whole opening of the arachnoid membrane completely. Nevertheless, the mesh-and-glue technique is a useful way of closing the arachnoid membrane, which will decrease the occurence of postoperative subdural hygromas.

• 日本脳卒中の外科学会の論文
• 2000-01-31

著者

• 永田 和哉

  公立昭和病院脳神経外科

• 永田 和哉

  公立昭和病院 リハビリテーション科

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