TachoSil Dural Reconstruction in Extracranial-Intracranial Bypass Surgeries

Background Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is a treatment option for hemodynamic insufficiency in the anterior cerebral circulation. Complications associated with extracranial-intracranial bypass surgeries are ischemic strokes caused by bypass failure, wound-healing disorders, and further issues from cerebrospinal fluid (CSF) leakage. CSF leakage can provide pathways for infection. It is well known in general neurosurgery that watertight closure of the dura mater is necessary to prevent such complications. Objective To provide a technical description of TachoSil dural reconstruction in standard STA-MCA bypasses and their follow-up analyses. Methods In this technical report with observational follow-up, the dura mater was closed partially by adaptive sutures, and the perforation site of the donor vessel was sealed with TachoSil. TachoSil is a collagen sponge covered with clotting factors that provides hemostatic and sealing effects. Results Our study included eight cases of standard STA-MCA bypasses that had been operated between July 2015 and September 2016. Follow-up examinations were completed for all patients at 1month and 6 months after surgery. Duplex and Doppler ultrasound demonstrated regular bypass patency in all patients without increased flow velocity at the perforation sites, which is a possible sign of stenosis. No wound-healing disorders or CSF leakage occurred. No cerebrovascular stroke events were observed. Conclusion Duraplasty with TachoSil enables the elastic reconstruction of the dura perforation gap in standard extracranial-intracranial bypass surgeries.