Comparison of dural closure alternatives: an experimental study.

Introduction: Dural closure preference has been a topic of debate in contemporary neurosurgery. This study aims to compare different closure techniques using an in vitro model.Methods: Human cadaveric dura mater was attached to a cylindrical metal glass filled with blue dyed saline. A 1 cm dural incision was made. Dural closure was performed using three different techniques. Each group had six samples: Group I - interrupted simple 4-0 polyglactin suture (S) only, Group II - S plus on lay collagen graft, Group III - S plus fibrin sealant. In Group NS, a 1 cm × 1 cm dural window was made. An onlay collagen graft was used with no suturing for this group to serve as an overtly weak reconstruction reference. Primary and secondary leak pressures were recorded (PLP and SLP, respectively).Results: All groups (I-III) had significantly higher PLP and SLP than Group NS. PLP was significantly higher in Group III as compared to groups I and II. Groups I and II had similar PLP values. SLP was similar in all three groups.Conclusion: In this study, the use of fibrin sealant has proven to be the best option in preventing dural leak. However, no technique was superior in the case of SLP.

Importance of Three-Dimensional Modeling in Cranioplasty.

Cranioplasty is a reconstruction operation made to protect intracranial structures. It is applied for the closure of bone defects occurring due to causes such as trauma, tumor, infection, and infarct. Many different products changing from autologous bone grafts to synthetic materials are used for cranioplasty. Three-dimensional printers that are among the popular innovations of today are used gradually more in medical area as in every field of life and they make the surgical operation easier. When customizable materials are combined with technology, the authors come across successful results and less complications. The aim of the authors' study was to show a 3-dimensional modeling method in 2 patients the authors applied cranioplasty and the advantages provided by this method for the surgeon and the patient.

A new 4-strand tendon repair technique in a rabbit Achilles tendon model: Is 4 better than 6?

OBJECTIVE: This study aimed to present a new modification of the modified Kessler tendon repair technique and share results of an animal study scrutinizing mainly the biomechanical properties and comparing it to other techniques. METHODS: Eighteen New Zealand rabbits were used and divided into 3 groups: 1 experiment and 2 control groups. Four-strand modified Kessler and 6-strand Tang repairs were used for the control groups. The new modification was used in the experiment group. Two surgeries were conducted 8 weeks apart, repairing 1 Achilles tendon in the first, repairing the contralateral tendon and harvesting specimens in the second. The repair times were recorded. In addition, biomechanical tests were conducted to determine mechanical strength. RESULTS: There was a statistically significant difference between the 3 groups in load-to-failure values for the strength after repair model, with the experiment group superior to the other 2 (P = .002; P < .05). Although there was a noticeable difference between the mean loadto- failure values of each group in the healing model, we could not demonstrate a statistically significant difference(P > .05). The new modification took significantly less time than the other 2 techniques (P = .001). CONCLUSION: Our new modification was biomechanically stronger and faster than the other 2 techniques. The technique offers a new, suitable, practical option for human flexor tendon repair.

Three-Dimensional Printing Assisted Preoperative Surgical Planning for Cerebral Arteriovenous Malformation.

OBJECTIVE: The aim of this study to investigate the benefits of patient-based 3-dimensional (3D) cerebral arteriovenous malformation (AVM) models for preoperative surgical planning and education. METHODS: Fifteen patients were operated on for AVMs between 2015 and 2019 with patient-based 3D models. Ten patients' preoperative cranial angiogram screenings were evaluated preoperatively or perioperatively via patient-based 3D models. Two patients needed emergent surgical intervention; their models were solely designed based on their AVMs and used during the operation. However, the other patients who underwent elective surgery had the modeling starting from the skull base. These models were used both preoperatively and perioperatively. The benefits of patients arising from treatment with these models were evaluated via patient files and radiological data. RESULTS: Fifteen patients (10 males and five females) between 16 and 66 years underwent surgery. The mean age of the patients was 40.0±14.72. The most frequent symptom patients observed were headaches. Four patients had intracranial bleeding; the symptom of admission was a loss of consciousness. Two patients (13.3%) belonged to Spetzler-Martin (SM) grade I, four (26.7%) belonged to SM grade II, eight (53.3%) belonged to SM grade III, and one (6.7%) belonged to SM grade IV. The mean operation duration was 3.44±0.47 hours. Three patients (20%) developed transient neurologic deficits postoperatively, whereas three other patients died (20%). CONCLUSION: Several technological innovations have emerged in recent years to reduce undesired outcomes and support the surgical team. For example, 3D models have been employed in various surgical procedures in the last decade. The routine usage of patient-based 3D models will not only support better surgical planning and practice, but it will also be useful in educating assistants and explaining the situation to the patient as well.