Treatment Strategy for Expanded Polytetrafluoroethylene Dura Substitute Infection

Abstract

  The purpose of this study was to establish a treatment strategy for postcraniotomy infection of expanded polytetrafluoroethylene (ePTFE) sheets used as artificial dura mater. Between 2002 and 2018, 27 cases of infected ePTFE sheets after craniotomy were treated. Several cases of delayed-onset infection and temporary remission were noted. Abscesses were localized to the artificial dura mater in 17 cases (63%), and combined epidural and subdural abscesses were noted in 10 cases (37%). The infected artificial dura mater was removed completely, and it was not replaced after the initial three cases in which autologous fascia lata was grafted for the dural defect. In one of these cases, infection recurred and the graft was removed. Of the 27 cases, 2 had skin defects, for which a vascularized free latissimus dorsi muscle flap with a skin graft was applied. Secondary cranioplasty using artificial bone was performed in 24 cases without complications. During cranioplasty, the pericranium was left intact on the brain surface with subgaleal scalp dissection in six cases in order to prevent cerebrospinal fluid (CSF) leakage. During long-term follow-up, no postoperative complications associated with the dural defect were observed. Subgaleal dissection cranioplasty is preferred for incomplete capsule formation on the brain surface. However, if the pericranium is unavailable, simultaneous transfer of vascularized free latissimus dorsi muscle for replacing the dural defect may be an option in cases with subdural abscesses to prevent CSF leakage during the secondary cranioplasty.