Clinical experience with the use of neuro-patch

Tuesday, 8 July 1997

IP-3-372I

Technology - Miscellaneous

ExpandedpolytetrafJuoroethylene surgical membrane as asubstitutefor the dura mater

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the operation in 5 cases of neck clipping for cerebral aneurysmsand 5 cases of STA-MCA anastomosis. In the malignantglioma cases,fluoresceinNa (8 mglkg bodyweight)was administeredinto the centralvenous line, and fluoresMitsuakiHatanaka. Departmentof Neurosurgery.Towada City Hospital, enhancedby CT and MRI. In the cases of cencewasobservedin tumortissues Towada, Japan aneurysm andthose undergoinganastomosis, the samedoseoffluoresceinwas A defect of the duramater, particularlyif accompaniedwithdamage to the administeredafter surgicaltrealment.Theconditionsof the parentvesselsof the arachnoid, may result inmeningealadhesion, cerebrospinalfluid (CSF) leakaneurysmsandanastomosedbloodvesselscouldbe monitored. age, infectionand cranial deformity. Widely usedhomologousmaterials as Discussion and Conctusion: As the absorptionpeak offluoresceinis 465 dried human dura mater may cause complications,such asCreuzfeld-Jacob to 490 nm,maximumfluorescenceis obtainedwith lightexcitationwithin this disease, deteriorationof thesubstitute,and tissuerejection. Expanded PoIyrange. It isappropriateto install an interference filter as an excitationfilter in tetrafluoroethylene(EPTFE) has excellent ant l-thrombotic , and non-adhesive system,for little loss of light and little generationof heat the light source optical characteristics(because of na tissueinfiltration)and is used to prevent adhe- by the filter. In the past,because an interferencefilter had not been used, it sionat varioussites in the body.The authorappliedEPTFE SurgicalMembrane was impossibleto devise a system in which there was no leak in the light, as in this system. Theadvantageof this system is that the filters can be instantly (ESM)as a substitutefor dura mater. Material and Method: ESM was applied in 165 cases of dural defect or switched. Thisrequiresno equipmentoutside of the microscope, and the ordinal difficulty of primary dural closure at the timedecompressive of craniectomy . imagecan beinstantlychangedto thefluoresceinimageduringoperation, with no time loss. ESMwith 1.0Ilm fiber length0.1 to 0.7 mm thicknesswas used. Several forms of implantationof ESM wereperformed; 1) water tight closure with suture, 2) depositionof the sheet in Insertioninto thesubduralspace withoutsuturing, 3) theextraduralspace.The degreeofadhesion, biocompability,deteriorationand P-3-37SI Photodynamictherapy of cerebralt umors: complicationsuchas CSFleakageandinfectionwereevaluatedat one weekto A long-termfollow-up 6 years afterimplantation. ShuganZhu, Jiajun Xu, LiqunJiao. DepartmentofNeurosurgery,TheAffiliated Result andConclusion:1) ESM can protectthe brain and surroundingtisHospitalof ShandongMedical University,Jinan,P. R. China sues in any of themethods.2) Noadhesionwasobservedat any suturesite. No deteriorationwas noted. 3) As tocomplications , temporaryCSF accumulation In ourseries, photodynamictherapy(PDT)wasperformedon 30 cases of cerewas observed in 25 cases and CSF leakage in 5 cases. Infectionsin 2 cases braltumors,including9 cases ofastroctytoma,12 cases of anaplasticastrocywereunrelatedto CSF leakage. 4) re-useandrepeated sterilizationis possible; toma, 3 cases ofgliolastoma,2 cases ofependymoma, 2 cases of metastatic cancersof brain, 1 caseof gangliocytomaand 1 case of malignantmeningioma. 5) EMS the material is easy to handle and many different sizes available. are recurrentglioma(7 recurrentanaplastic Amongthesecases, thereare9 casesof can be used as atemporaryor permanentsubstitu1e for the duramater. astrocytoma.1 recurrentgliobastoma, and 1recurrentependymoma). Haemotoporphyrin derivative (HPD) was administered intravenouslyat a dose of 4 to 7 mglkg, 5 to 24 hours before operation. All patients underwent a craniotomy P-3-373' Clinicalexperience with the use of neuro-patch with a nearlyradical or partial excision of the tumor following which the tumor P. Cejpek, V.Srnrcka, DepartmentofNeurosurgery,UniversityHospital, bedwasirradiatedwith 630 nm laser light emitting, an argon pumpeddye laser Bmo-Bohunice, Czech Republic to minutes witha total andlorfrequencydoubleYAGpumpeddye laserfor 20 90 dose of 100J/sq em (n =5) 150 J/sq em (n =2), 200 J/sq em (n =22) and 300 Introduction:Since 1995, we have been using the Neuro-Patch- a micropJ/sq em (n = 1). The temperaturewas kept at 37centigradeby irrigation.Two orous,nonabsorbablepolyesther-urethaneproducedby B. BraunMelsungen patientsunderwentpostoperativeradiotherapy . One patientunderwentpostopAG Company. We have tested thisalloplasticmaterial in order to apply it as erativechemotherapy.There was no evidence of increasedcerebraledemanor a.durasubstitute . We havecomparedNeuro-Patchwith the until very recently dischargedfromhospitalwithin usedautoloqousmaterials(such as galea, periost or fascia lata) and homolo- othertoxicitybylhe therapyandall patientswere t5 days afteroperation.The patientswerefollowedfor 96 to 97 months. The gous tissues(naturalimplantsfromIyophilisedhumandura mater). mediansurvivalwas 25.5 months with 1, 2, 3, 5 and 8 years actuarial survival Methods: The study is basedupon 562 intracranialand 22intraspinaloperrate of 50%, 29%, 25%, 10% and 10% (30 cases)respectively . Three of the 30 ationsFrom May1995to June 1996. During this periodof time Neuro-Patchwas patients are alive, they were followed clinically for 96, 96 and 97 months with used in 23 cases,autologousmaterialsin 39 casesandhomologoussubstitutes recurrence. The CT scan showed no evidence of in 33 cases.The complications relatedto the duraplasty (such as infection, CSFno clinical evidence of tumor diseasein all of these cases. retrospective ly. Fistula,pseudocystsand meningitis) were investigated We concludethat PDT using 4.7 mglkg of HPD and 630 nm lightwith a dose mentionedperiod of time dura substitutewas required Results: Within the of up to300 J/sq em can be used as an adjuvant therapy with no additional with afrequencyof 17.6%inintracranialoperationsand a frequencyof 14.4% complications,postoperativeradiotherapyis safe. in intraspinaloperations.Complicationswere observedmostfrequentlyafter operationswithlyophiliseddura matersubstitutes(6.8%), in 4.8% of the cases withautologoussubstitutes.The rate ofcomplicationswas the lowest(1.5%) I P-3-376I Thermal monitoringsystem duringdrillingwitha after operationswith Neuro-Patch. high speeddrillin skull basesurgery Discussion:Accordingto the study it seems that, next to the autologous substitutes,Neuro-Patch is certainly the most suitable substitutefor the dura SoichiroKondo, AkiraKobayashi, HirokazuNagata. Department of craniocerebralinjuries,open spina mater. However, it cannotbe usedfor open Neurosurgery,NeurologicalInstitute,Nagahama City Hospital, Nagahama, contaminatedareas. In contrasttoIyophilisedduramater, bifida or implants in Japan na bacterial and virus disease check is necessary beforeoperation an with Introduction:The recentadvancesin skull base surgery are remarkableand Nsuro-Patch. the high speed drill tends to be used frequently during micro neurosurgery . Conclusion:Accordingto the results of study, Neuro-Patch appears to be the most suitablereplacementmaterial for duraplastyoperations for both However, the heatgenerated by high speed drilling can cause cranial nerve injury or spinalinjury. In order to monitor thetemperature of the drill burr practicaland ethicalreasons. performedthermography with our original devices. and tissues around it, we Furthermorewe examined the effect of cold water irrigationon the high speed drilloperation. P·3-374I Developmentof fluoresceinoperativemicroscope , we usedaTVS-1ooME producedby NIPPON Methods: Forthermography ToshihikoKuroiwa,YoshinagaKajimoto, TomioOhta.Departmentof AVIONICS INC. The scan speed was10 frames per second. We used special Neurosurgery.Osaka Medical College,Takatsuki City, Japan mirrors and ateleconversionlens to observe the deep and small microsurgi· Introduction:In the field ofneurosurgery , various uses have been made of cal operativefield. Weperformedthermal monitoringduring 24microsurgical operations with a high speed drill (Black Max: ANSPACK EFFORT INC., a.v. fluoresceinduring surgery. However, these uses were not practicalbecause fluorescenceenhancementor contrastwas inadequate due to an inappropriate 70.000 rpm)andrecordedthe data on video tape or a 3.5 inch floppy disk. (A: light source or filter. We developed a system in whichoperative an microSpinaloperations7, B: Optic canalunroofing6, C: Drilling of internal acoustic monitoringwithsufficient meatus 5, D: Others 6) Wecompared the temperatureof the operative field scopeis equipped with excitationand barrierfiltersfor irrigated with room temperature(RT) water and that irrigated with cold water fluorescenceenhancementandcontrast. Methods: For the operative microscope, ZeissOPMI MD and OPMICS-NC « 4°C). Results: In spiteof the rapid movementof the drillburr, we could monitorthe were used. Superlux 300, a xenon lamp, was used as the light source. As temperatureexactly in real time. Thetemperatureof the operative field could the excitationfilter for the light source optical system, BP 450-490, a glass be kept under42°C. The temperature in each operative field with RT water microscopeoptical interferencefilter, was used. As the barrier filler for the irrigationwas as follows (mean ± SO):A =39.1 ± 1.26, B =36.6 ± 1.90, C = system, KodakWratten No. 12 made of gelatinwas used. 38.7 ± 1.35, 0 = 39.0 ± 1.34. The temperaturewith cold water irrigation was: removalin 10casesof maligResuits: This systemwasappliedduringtumor nant gliomaenhancedby CT and MRI. It was also usedfor angiographyduring A =15.9 ± 1.72"C(p=0.018), B =14.8 ± 1.47 (p =0.028),C =13.8 ± 1.20 (p

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