DETAILED EVALUATION OF 2959 ALLOGENEIC AND XENOGENEIC DENSE CONNECTIVE-TISSUE GRAFTS (FASCIA LATA, PERICARDIUM, AND DURA-MATER) USED IN THECOURSE OF 20 YEARS FOR DURAPLASTY IN NEUROSURGERY

Surgical experience with 2959 allogeneic and xenogeneic dense connecti ve tissue grafts (1767 of fascia lata, 909 of pericardium, and 283 of dura mater), used in 2665 neurosurgical operations performed in the co urse of 20 years (1976 to 1995) is reported. Duraplasty using either a llogeneic or xenogeneic grafts has had a similar, and favourable clini cal outcome. Nevertheless, the pliable deep frozen fascia lata grafts, which could be used in any location, have been reserved for sella tur cica plugging, anterior cranial base plasty, aneurysmal wrapping, and surgery of lipomyelomeningocele. Pericardium and dura mater grafts wer e in the majority of cases used over the brain convexity and posterior cranial fossa. Ovine pericardium proved to be superior to bovine and allogeneic pericardia because of its workability, flexibility, reduced thickness, and better transparency. Postsurgical complications occurr ed in 7.3%, and they were: 1) cerebrospinal fluid fistulas in 2.8%; 2) meningites in 2.3% (aseptic 1.4%, bacterial 0.8%, and tumoural 0.1% m eningites); 3) pseudomeningoceles in 2.2%; 4) wound infections in 0.6% ; 5) malresorptive hydrocephalus in 0.5%; and 6) adhesions to nerve ti ssue in 0.5%. The majority of complications healed without surgery. Fo rty-eight grafts (1.6%) failed to fulfil the requirements of the surge on, and 46 of them were re-operated upon. Though another thirty-nine g rafts healed successfully, 39 shunts (1.5%) had to be performed for ma lresorptive hydrocephalus (0.9%), and/or for a big pseudomeningocele ( 0.6%). So, the pure complication rate in 2665 duraplasties was 3.1%. T he complex evaluation of the allogeneic and xenogeneic grafts (fascia, pericardium, and dura mater), used for duraplasty in neurosurgery dur ing the last 20 years proved them, as remarkably good, with a success rates of 96.9%.