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Tethered brain: disentangling unintentional brain-mesh interfaces. Illustrative case
Samantha E Spellicy1, Joseph R Kilianski2, Rachel Poston2
1Departments of Neurosurgery and.
Journal of Neurosurgery. Case Lessons
|July 20, 2022
Summary
Surgical mesh can inadvertently tether to brain tissue, causing neurological issues. Prompt disentanglement and use of dural substitutes are crucial for preventing this complication in neurosurgery.
Area of Science:
- Neurosurgery
- Neurology
- Biomaterials
Background:
- Surgical meshes are common in neurosurgery.
- Risks include infection, exposure, and foreign body reaction.
- Mesh tethering to neural structures is an overlooked risk.
Observation:
- A 68-year-old woman developed intractable seizures and motor deficits 9 years post-cranioplasty.
- MRI revealed progression of encephalomalacia and potential cortical tethering to the mesh.
- Surgical intervention was performed to remove the tethered mesh.
Findings:
- The case details the first reported disentanglement of mesh from cortical tissue.
- Successful surgical removal of the tethered mesh was achieved.
- The procedure required meticulous microdissection and electrocautery.
Implications:
- Dural substitutes are recommended during cranioplasty to prevent neural tissue scarring and tethering.
- Careful surgical technique is vital to minimize damage during mesh removal.
- Highlights the importance of considering mesh-related complications in neurosurgical outcomes.
