gms | German Medical Science

Objective: One significant drawback during a cranial reoperation is the presence of meningo-cerebral adhesions. The appearance of these connective tissue bridges between the inner surface of the dura and the pia-arachnoid is directly related to the dural closure in the previous surgery. This study was done to determine the benefit of using a thin-layer gelatin sponge of polypeptides to prevent the development of meningo-cerebral adhesions.

Method: From September 2005 to May 2012, 902 craniotomies were done for various lesions by the senior author (U.T.). Beginning with February 2009 we began placing thin gelatin layers underlying the dural flap with the aim of protecting the brain surface during dural closure and isolating the dural healing. To determine the benefits of this technique, the reoperation cases were inspected prospectively and the degree of meningo-cerebral adhesions were compared between group G (Gelatin) and C (Control) in which the dural closure was made with and without subdural application of the gelatin sponge respectively. Student's t-test and χ² tests were used for comparison for means of the variables and normally distributed data. Results were expressed as the mean ± SD. p<0.05 was considered as significant.

Results: Patients with these gelatin layers did not show any local or systemic complications related to the sponges. In all patients of group G (n=15), a neo-membrane was found when the dura was re-opened. This layer was easily dissected and showed no or minimal adhesion to the underlying cerebral cortex. However in group C (n=14) significant meningo-cerebral adhesions in various degrees were detected. The adhesion scores were significantly higher in group C than in group G (p<0.001)

Conclusions: During the dural closure placing a thin layer of gelatin sponge in the subdural space is a safe and effective method for preventing meningo-cerebral adhesions.