Silastic duraplasty in pediatric patients

Frederick Boop, W. M. Chadduck

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

The role of adhesions in the retethering of the neural elements after surgical treatment of spinal dysraphism has produced refinements in the technique of the closure of the neural tube. Silastic, because of its relative inert property, has been used for duraplasty, but a few reports of late complications of hemorrhage or fibrotic capsule formation have caused concern over its use. We report 33 patients with the following diagnoses - eight spinal lipomyelomeningoceles, three myelomeningoceles, six symptomatic Chiari II malformations, seven tethered cords, six spinal cord tumors, two diastematomyelia, and one cerebellar astrocytoma - in whom Silastic dural grafts were used to prevent the adherence of neural structures to the overlying tissues. Our surgical technique is presented here. The patients have been observed for up to 6 years. Only one became infected, was treated with antibiotics without graft removal, and has remained without sequelae for over 3 years. One had an incidental pseudomeningocele that was noted on follow-up magnetic resonance imaging scan that was not clinically apparent. There have been no hemorrhages, leakage of cerebrospinal fluid, nor other complications from using nonreinforced Silastic sheeting. In one patient, Dacron-reinforced Silastic was used and, upon reexploration, a marked fibroblastic response was noted. A review of the literature suggests that fibrotic complications are related to this Dacron-reinforced Silastic. The hemorrhagic complications that were reported occurred in instances where Silastic grafts were large and no technical modifications were made preventively. We conclude that the use of nonreinforced Silastic dural grafts, with appropriate technical modifications in surgical technique, is safe and may prevent retethering of neural tissues in a variety of neurosurgical lesions.

Original languageEnglish (US)
Pages (from-to)785-788
Number of pages4
JournalNeurosurgery
Volume29
Issue number5
DOIs
StatePublished - Jan 1 1991
Externally publishedYes

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Pediatrics
Transplants
Polyethylene Terephthalates
Spinal Cord Neoplasms
Hemorrhage
Meningomyelocele
Neural Tube
Spinal Dysraphism
Neural Tube Defects
Astrocytoma
baysilon
Capsules
Magnetic Resonance Imaging
Anti-Bacterial Agents
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Silastic duraplasty in pediatric patients. / Boop, Frederick; Chadduck, W. M.

In: Neurosurgery, Vol. 29, No. 5, 01.01.1991, p. 785-788.

Research output: Contribution to journalArticle

Boop, Frederick ; Chadduck, W. M. / Silastic duraplasty in pediatric patients. In: Neurosurgery. 1991 ; Vol. 29, No. 5. pp. 785-788.
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