Evaluation of the Results of Using Silicone Membrane between Muscle and Dura after Craniotomy in Patients Requiring Delayed Bone Replacement at the Craniotomy Site: A Prospective Cohort Trial

Background: The adhesion between the dura and the muscle is one of the serious problems of patients who need delayed cranial bone replacement due to decompressive craniotomy after brain swelling, but there is no ideal solution to reduce this complication. This study aimed to determine the effect of implanting a silicone membrane between the muscle and the dura after craniotomy surgery in patients requiring delayed bone replacement at the craniotomy site.Methods: In this clinical prospective cohort trial study with no evidence, all patients undergoing late cranial bone grafting after craniotomy were selected, and a total of ۲۴ people were included in this study. During the craniotomy, a silicone mesh measuring ۵ × ۵ cm was placed between the dura and the muscle. Adhesion between the dura and the muscle and side effects associated with this procedure were examined during cranial bone grafting.Results: Out of ۲۴ patients requiring delayed cranial bone grafting, three individuals died and six individuals did not refer for cranioplasty; therefore, the operation was performed on ۱۵ patients. During the operation, no cases of muscle-dura adhesion were observed, and in all ۱۵ patients, the dura was completely detached from the muscle. Also, none of the patients presented side effects such as muscle bleeding at the surgery site, infection, and allergy to the mesh.Discussion: Implantation of silicone layer between the dura and the muscle during craniotomy in patients suffering from cerebral edema can prevent muscle-dura adhesion without causing serious complications for the patients.

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Keywords: Cerebral edema ، Craniotomy ، Cranioplasty ، Adhesion