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DOI: 10.1055/s-0037-1600805
Dural Closure In Confined Spaces of the Skull Base with Nonpenetrating Titanium Clips
Publication History
Publication Date:
02 March 2017 (online)
Objective: Dural repair in areas with limited operative maneuverability has long been a challenge in cerebral surgery. This is especially true in skull base meningiomas and other dural-based lesions, where aggressive dural resection is often limited by the inability to repair dural defects in confined spaces. Without adequate dural closure, postoperative complications including cerebrospinal fluid leaks and infection can occur. Here, we show a novel method by which nonpenetrating titanium clips can be used to repair dural defects in areas with limited space.
Case Presentation: We present two patients who underwent dural repair with vascular microclips. Both repairs involved difficult-to-reach areas in which primary dural suturing was impractical: one case involved a clinoidal meningioma and the other a recurrent cerebellar hemangiopericytoma extending below the foramen magnum.
Technique: Our method utilizes a clip applier to repair dural defects. The applier contains twenty-five, 3-mm titanium clips that are applied to the dura by squeezing a lever resting under the surgeon’s thumb and forefinger. The clips are rapidly placed in an interrupted fashion, similar to applying skin staples for wound repair. With forceps apposing the edges of the dura and graft material, the clips are inserted circumferentially until completion.
Conclusion: In our experience, intracranial dural closure with nonpenetrating, nonmagnetic, titanium clips is an effective method for dural repair in spaces with limited operative maneuverability.
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No conflict of interest has been declared by the author(s).
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