IATROGENIC CREUTZFELDT-JAKOB-DISEASE AND ITS NEUROSURGICAL IMPLICATIONS

Creutzfeldt-Jakob (CJD) disease has been reported after the insertion of dural homografts. Two Australian cases of CJD, both following poste rior fossa craniotomies done in 1982, are reported; the incubation per iods were 5 and 12 years. It seems highly probable that the associatio n is causal. CJD infective agents (prions) are resistant to many previ ously accepted means of sterilisation and it is postulated that cadave r dural material was either derived from subjects with CJD, or was con taminated during preparation, In Australia the use of dural homografts in neurosurgery was abandoned in 1987; as the mean incubation period (determined from a world-wide review) has been about 65 months, it is now hoped that this: cause of CJD will not recur in the Australian pop ulation, although it is premature to state this with confidence, Howev er, precautions against case-to-case transmission remain necessary, an d guidelines for this purpose should be enforced in theatre practice a nd in organ donations. (C) Pearson Professional 1996.