Dural tear is a tear occurring in the

dura mater In neuroanatomy, dura mater is a thick membrane made of dense irregular connective tissue that surrounds the brain and spinal cord. It is the outermost of the three layers of membrane called the meninges that protect the central nervous system. ...

of the brain. It is usually caused as a result of trauma or as a complication following surgery. __TOC__

Diagnosis

In case of head injury, a dural tear is likely in case of a depressed skull fracture. A

burr hole Trepanning, also known as trepanation, trephination, trephining or making a burr hole (the verb ''trepan'' derives from Old French from Medieval Latin from Greek , literally "borer, auger"), is a surgical intervention in which a hole is drille ...

is made through the normal skull near the fractured portion, and Adson's elevator is introduced. Underlying dura is separated carefully from the overlying depressed bone fragments. The dura that is now visible is carefully examined to exclude any dural tear.

Treatment

The whole extent of the dural tear is exposed by removing the overlying skull. The ragged edges of the tear are excised. However, care should be taken not to excise too much dura as it may increase the chances for spread of infection into the subarachnoid space. Removing too much dura will also make it difficult to close the tear. If there is not much dural loss, interrupted sutures are made with non-absorbable material. In case of dural loss, the defect is closed using a transplant from fascia lata or pericranium given that there is not much contamination of the dura. In case of contamination, the defect is left alone and a primary suture is performed at a later date. If dural tear is associated with haemorrhage from dural vessels, they are coagulated using diathermy. This technique is preferred because the vessels are too small to be picked up by an artery forceps. Large vessels, if present, can be under-run with suture. When the dural tear is associated with a dural sinus hemorrhage, a graft of

pericranium The periosteum is a membrane that covers the outer surface of all bones, except at the articular surfaces (i.e. the parts within a joint space) of long bones. Endosteum lines the inner surface of the medullary cavity of all long bones. Structure ...

is used for a small tear and a muscle graft from

temporalis In anatomy, the temporalis muscle, also known as the temporal muscle, is one of the muscles of mastication (chewing). It is a broad, fan-shaped convergent muscle on each side of the head that fills the temporal fossa, superior to the zygomatic a ...

is used for a large tear. The muscle graft is flattened by hammering before using it for grafting. If dural tear is associated with a brain injury, wide exposure of the wound is done to examine the extent of brain damage. All devitalized brain tissues are removed along with extravasated blood, foreign bodies and pieces of bone. All devitalized tissue and foreign bodies are removed by a combination of irrigation and suction. Following dural repair, skull deficit is treated by using moulded tantalum plates or acrylic inlays, three to six months after the head injury.

References

{{reflist Brain disorders Trauma surgery Neurosurgery