Efficacy of placing a thin layer of gelatin sponge over the subdural space during dural closure in preventing meningo-cerebral adhesion

Objective One significant drawback during a cranial reoperation is the presence of meningocerebral adhesions. The appearance of connective tissue bridges between the inner surface of the dura and the pia-arachnoid is mostly related to dural closure and the condition in which the surgical field was left in the previous surgery. This study was done to determine the benefit of placing a thin-layer gelatin sponge of polypeptides subdurally to prevent meningocerebral adhesions. Methods From September 2005 through May 2012, 902 craniotomies were performed for various lesions by the senior author (U.T.). Beginning in February 2009, we began placing a gelatin sponge under the dural flap to isolate the dural healing process from the cortical surface. To compare the degree of meningocerebral adhesions statistically, reoperation cases between February 2009 and May 2012 were divided into 2 groups as group G (gelatin) and group C (Control) in which the dural closure was made with and without subdural application of the gelatin sponge, respectively. Results In all patients of group G (n = 15), a neomembrane was found when the dura was opened. This layer was easily dissected and showed no or minimal attachment to the underlying cerebral cortex. However, in group C (n = 14), meningocerebral adhesions in various degrees were detected. Adhesion scores were significantly greater in group C than in group G (P < 0.001). Conclusion This study proves that, during the dural closure, placing a thin layer of gelatin sponge in the subdural space is a safe and effective method for preventing meningocerebral adhesions. © 2015 Elsevier Inc. All rights reserved.