Application of collagen sponge as an artificial dura mater in epilepsy surgery after invasive monitoring to prevent cerebrospinal fluid leakage

Objective To analyze the effect of collagen sponge as an artificial dura mater on repairing dural defects and preventing cerebrospinal fluid (CSF) leakage during epilepsy surgery after invasive intracranial electrode monitoring.Methods A total of 64 patients who underwent epilepsy surgery after invasive intracranial electrode monitoring in our hospital from January 2009 and June 2012 were involved in this study.Forty-nine patients were divided into two groups according to the methods using dural substitute for the closure of dural defects.Group A consisted of 22 patients,whose dural substitutes were placed on the dural defect after the dura mater was sutured.Group B consisted of 27patients,whose dural substitutes were used subdurally before the dura mater was sutured.As a control group (group C),there were 15 patients undergoing similar epilepsy surgery without using artificial substitutes.Results Five patients from group C (33.3％) had the postoperative complication of CSF leakage and subsequent accumulative liquid under scalp flap,whereas 5 patients were found in group A (22.7％) and 2 patients in group B (7.4％) with significant difference (P＜0.05).All patients were treated by compression bandaging after manual drainage.Two patients in group A and three patients in group C were cured by closed continuous drainage of CSF via lumber subarachnoid catheter.Conclusions Using collagen sponge as an artificial substitute during epilepsy surgery can reconstruct the integrity of dura mater and reduce the incidence of CSF leakage.Artificial dura mater used subdurally is more effective than that used extradurally in preventing CSF leakage. Key words: Epilepsy surgery;  Invasive intracranial electrode monitoring;  Cerebrospinal fluid leakage;  Artificial dura mater of collagen sponge;  Dural repair