Usefulness of silicone elastomer sheet as another option of adhesion preventive material during craniectomies

Objective: We describe the use of a silicone elastomer sheet (SILASTIC^®) to prevent peridural fibrosis in patients who underwent a craniectomy and a subsequent cranioplasty. Materials and methods: We performed a decompressive craniectomy and a subsequent cranioplasty with an autologous bone flap in 50 patients (mean age, 40 years) between 1996 and 2005 at our institution. Most of the craniectomies were performed as an emergency procedure for relief of brain swelling. The standard decompressive craniectomy technique that we performed included bone removal and a duroplasty in 26 of the 50 patients, however, a SILASTIC^® sheet was added to the standard decompressive craniectomy in the remaining patients in an attempt to prevent dural adhesions. The development of adhesion formation between the tissue layers was evaluated during the cranioplasty in terms of operative time and the amount of blood loss. Results: During the cranioplasty, we observed that the SILASTIC^® sheet succeeded in creating a controlled dissection plane, which facilitated access to the epidural space, shortened the operative time by approximately 24.8% and diminished the intraoperative blood loss by 37.9% as compared with the group of patients who underwent the standard cranioplasty. These differences were statistically significant (p < 0.05). Conclusions: The use of a SILASTIC^® sheet to prevent peridural scarring and to facilitate cranioplasty in patients who have previously undergone a craniectomy is a good technique, regardless of the procedural indication.