Silastic duraplasty in pediatric patients

Area of Science:

• Neurosurgery
• Biomaterials Science

Background:

• Adhesions after spinal dysraphism surgery can cause neural element retethering.
• Silastic has been used for duraplasty, but concerns exist regarding hemorrhage and fibrotic capsule formation.

Purpose of the Study:

• To evaluate the safety and efficacy of nonreinforced Silastic dural grafts in preventing neural tissue adherence.
• To present a surgical technique utilizing Silastic grafts for various neurosurgical conditions.

Main Methods:

• Retrospective review of 33 patients undergoing neurosurgery with Silastic dural grafts.
• Inclusion of diagnoses: spinal lipomyelomeningoceles, myelomeningoceles, Chiari II malformations, tethered cords, spinal cord tumors, diastematomyelia, and cerebellar astrocytoma.
• Detailed presentation of the surgical technique and patient follow-up up to 6 years.

Main Results:

• No hemorrhages or cerebrospinal fluid leakage observed with nonreinforced Silastic sheeting.
• One infection treated successfully with antibiotics without graft removal.
• A single case of pseudomeningocele noted incidentally on MRI.
• Dacron-reinforced Silastic was associated with a significant fibroblastic response.

Conclusions:

• Nonreinforced Silastic dural grafts are safe and effective in preventing neural tissue retethering.
• Appropriate technical modifications are crucial for successful Silastic graft utilization.
• Dacron-reinforced Silastic may be linked to adverse fibrotic complications.