Re: dura patch question & others

[Guest guest]

<< 1. I am wondering if any of you know what keeps the dura patch from

leaking spinal fluid? I realize that some leakage is a problem, but

when I sew a patch on a water resistant rain jacket, it will leak

where the needle holes are.

This answer below is only ONE way the problem is approached /solved ...other

neurosurgeons don't all do the same thing . The neurosurgeon who did my

decompresion uses a dura patch material harvested from your own scalp

material . He then SEALS the graft after its sewn using a glue type substance

called cyroprecipitate that is made from a substance in your own blood .

.....There is an article on sealing skull based surgerys that explains this

approach found in a recent Neurosurgical Focus issue where you can look up

and read more about this approach if you want too . I've heard of other ways

to seal those pinholes up /but forgotten the names of the glue type

substances other neurosurgeons use now - sorry .

Thought while this topic is being discussed I'd mention too that the various

graft materials are said by the neurosurgeons to all work equally as well

....they say the real differance is in having gained experience using a given

material . ...some physicians also use teflon or similar material under the

dura patch to help suport the area and or to help keep tissue from adhearing

/scaring to other structures nearby . That isn't mentioned here on the suport

group as often but at the ASAP lectures it is discussed as being a pretty

routine measure to use /take . I had a teflon patch added as well .

One of the neurosurgeons was trying to explain the TEXTURE of dura and

discribed it as being much like thick jello . They explained a needle pinhole

ACTS much like one in Jello too ..it leaves a small tract hole where its been

punctured like you can SEE IF you were to stick a needle through jello then

examine it with light shining through . ...This tract can allow some fluid

leeking until it melds back together ...in a spinal tap this typically

happens in the first few hours ( can take a few days /hense spinal headaches

and use of a blood patch when they don't close up . ) ...with that graft the

cyroprecipitate glue seals the tract holes up right away / and typically the

doctor will place a bit of internal presure on the graft so he can check for

a good seal before closing up the incision too .

2. Please forgive me if I have already ask this question, but what

is this cauterizing of the tonsil all about? I am not quite sure on

why it is done.

typically only a small amount of the tonsils tissue would be burned away and

there are several reasons a doctor may recomend this .

....this tissue has NO known purpose ( and no long term impacts being gone )

but is blocking the path of good flow ...and frequently the presure this

tissue has been under will have dammaged it as well leading to NO

signigigant hope that the tissue could recover and become functional again .

Another reason it may be proposed /done is ...when those tonsils are below

the level of c1 at all ( typically around 12 mm in herniation debth ) then

there is an issue /need to remove part of c2 ( NOT JUST C 1 ) to get the

presure relieved . If burning off a few mm of tissue will avoid this there

are good reasons to consider it too .

Removing part of c2 is known to lead to greater incidence of cervical

instability for example post decompresion ...and there is a greater need for

suport post op ( a rigid collar is usually needed for awhile ) / a greater

degree of discomfort in recovery and slower healing time ...in short a more

complex surgery to carry out / more risks in possible cervical shifting later

and a slower recovery time ect . can all be avoided with cauterisation in

SOME folks . This won't be true for everyone with those deep herniations but

is for quite a few of them .

Burning it away when dammaged and scared ect made total sense to me .

.....they still don't know of any known functions for it /and those of us

who've had this done havn't had any major problems as a result either .

.....It makes great sense to me as a former nurse ...maybe that comes from

having seen dammaged tissue /scared tissue ect in front of my eyes in other

situations ...but heck such a simple thing to regain better flow ? To me it

seemed best to do ALL that could optimise surgery being sucessful and avoid

the possible need for further surgery .

My neurosurgeon also said that the tonsils will frequently PULL UP some in

responce to the cautery ...he then sews the graft in a way it acts somewhat

like a sling or hammock helping to KEEP them up that bit more too .

Not all neurosurgeons chose to do this ....hense debate umongst US about what

is better ...they don't typically argue this point themselves much having

experience themselves with using cauterisation in other contexts /uses .

I have heard them say in agreement though that it is a good viable

alturnative to those c2 lamenectomys that more and more they feel is

justified in considering seriously even when they arn't the doctors ROUTINELY

doing cauterisation . Many reserve this decison until they are inside your

chiari area then may decide based on what they find which is best too .

While on this topic I'll throw in that another reason they may sugest opening

the dura that we don't discuss often here is ...a signifigant percentage of

us also have some tough bands of tissue at the level of the foramen that bind

or constrict the tonsils tissue ( I heard one doctor discribe these as sort

of like a rubber band wraped around a few times /twisted to keep them tightly

constricted ) ...unless these bands are found and removed they may well

hinder good results . They can't be seen on MRI or through the dura ...so the

doctor must GUESS if they are there ( more typical of acm 2 as I recall but

may be there with acm 1 ) ...or open the dura to be sure . ( it must be

opened to remove these ) .

My nsg also said that occationally he will find something totally unexpected

when he gets inside too ...he likes to go that slight extra distance and MAKE

sure he has fully found /addressed someones problems when he's there the

first time KNOWING that if he doesn't go clear to the level of that tonsil

tissue being exposed and MAKING Sure the csf is moving freely - he may well

find himself later going back in to finnish a job that would have much more

easily be addressed the first time for BOTH the patients sake /and reducing

the amount of surgery needed for good results ...again this made great sense

to me .

3. My doctor mentioned something about part of the tonsil (I think

that is the part she said) actually being dead because of being

compressed too long? Has this happened to anyone and are there any

noticeable problems that can't be compensated for by the rest of the

brain?

Usually this would refer to the tonsil tissue as discribed above . ...Folks

who've had the tonsils cauterised recover at the same rate ( or better if

flow is still blocked by having left the tissue there ) . Studies have looked

at the sucess rate using cautery and found it seems to offer greater

improvements as I recall the discussion at ASAP . NO study has ever

demonstrated any long term harm at all from doing it .

4. Also a question about long hair vs. short hair? What have the

females on here done as to hair length prior to surgery and after? I

have heard two stories, one story for each length. I was just

thinking that long hair might get in the way, and be harder to take

care of.

My hair is waist lenght ...I left it long braided in 4 pigtails the morning

of surgery . The doctor shaved but left the hair braided in ...later I just

brushed it out ( a week later ) ...having braids /parts ment using some scalp

cleaning sheets wasn't hard to clean away some scalp oil /feel fresher ...and

the long hair covered MOST of the shaved area . ( I had two incsions ..one

made to harvest the graft material ...so about 2/3 of the back of my head was

shaved . )

Again this is something that will vary from Doctor to Doctor ...by all means

talk to yours about what he feels is best . I got bashed for my offhand

comment last week that I wasn't wanting to debate a topic of my post ...so

I'll leave this wide open and say I'm glad to discuss my understanding of

these issues more ....but I'd sugest ANYONE who can -- consider renting a

couple of the neurosurgeons lectures from ASAP to get this info accuratly

....I tend to forget LOTS of the details they cover in the tapes /and remember

bits inaccuratly too ...it's a much better source of info. too understand the

variations between doctors and the details of what they feel works best .

....ASAP's website url is changing ...the new web site is http://ASAP.org .

The lectures are available to rent for $10 a tape ...I'd sugest starting with

a tape each by Dr Milhorat / Oro / and Batzdorf or Ellenboggen to grasp the

range between assertive and conservative ...there are other approaches as

well /but these are a great starting place . Do consider copying the tapes

while you have them both to later refresh your memory /understanding and to

share with your local care providers .

Hope that helps ...again it's just MY understanding of these Q .

in Paradise

[Guest guest]

A bit more on cryoprecipitate.

cryoprecipitate is also something that is given to people with some types of

hemophilia when they are having bleeding problems.

For those of us with bleeding disorders, it comes in handy when we have

severe bleeds. Although I have not yet had the pleasure of experiencing

direct use of cryoprecipitate (knock on wood it stays that way),

my brothers and nephew have needed cryoprecipitate ... and ... it works. :-)

---

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[Guest guest]

Hi all ....

Adam is having his surgery on January 3rd with Dr. Batzdorf in LA.

What he told us he was going to do was use Adam's own dura for the graft plus

a piece of goretex to stiffen and then the cryprecipitate for the glue! He

also said the he would shrink the tonsils........

Laurie

[Guest guest]

I had wanted to reply to the group because of the mention of dura patches

and the substance of them not making a difference.

Dr. Frim in Chicago- a experienced doctor in chiari- does not use artificial

dura patches in his surgeries. He has also recently written a paper on why

a natural (patch made of your own tissue) should be used and advising

against the use of artificial patches.

We ended up at Dr. Frim because our daughter did fabulous initially and then

ended up getting symptom after symptom slowly return. Her dura patch is

made of gortex. It has reacted with her body and caused scar tissue

buildup.

Dr. Frim said that for this very reason he does not use artificial patches

for his surgeries and has done a paper on such topic.

I don't think anyone should be alarmed if they have an artificial patch.

This probably does not effect everyone. However, I wish I had been informed

that there was a chance of rejection and a greater chance of scar tissue

buildup before our daughters operation.

She now needs a second operation to replace her durapatch with one made of

her own tissue. I don't mean to bring up a large discussion or anything but

I think it is best to know all. I am sure the artificial patches are ok and

if you are with a surgeon that you trust go with their advice. Just

remember that information is power and to question when necessary.

Hope this helps.

(WI) 's Mom

Re: dura patch question & others

<< 1. I am wondering if any of you know what keeps the dura patch from

leaking spinal fluid? I realize that some leakage is a problem, but

when I sew a patch on a water resistant rain jacket, it will leak

where the needle holes are.

This answer below is only ONE way the problem is approached /solved ...other

neurosurgeons don't all do the same thing . The neurosurgeon who did my

decompresion uses a dura patch material harvested from your own scalp

material . He then SEALS the graft after its sewn using a glue type

substance

called cyroprecipitate that is made from a substance in your own blood .

.....There is an article on sealing skull based surgerys that explains this

approach found in a recent Neurosurgical Focus issue where you can look up

and read more about this approach if you want too . I've heard of other ways

to seal those pinholes up /but forgotten the names of the glue type

substances other neurosurgeons use now - sorry .

Thought while this topic is being discussed I'd mention too that the various

graft materials are said by the neurosurgeons to all work equally as well

....they say the real differance is in having gained experience using a given

material . ...some physicians also use teflon or similar material under the

dura patch to help suport the area and or to help keep tissue from adhearing

/scaring to other structures nearby . That isn't mentioned here on the

suport

group as often but at the ASAP lectures it is discussed as being a pretty

routine measure to use /take . I had a teflon patch added as well .

One of the neurosurgeons was trying to explain the TEXTURE of dura and

discribed it as being much like thick jello . They explained a needle

pinhole

ACTS much like one in Jello too ..it leaves a small tract hole where its

been

punctured like you can SEE IF you were to stick a needle through jello then

examine it with light shining through . ...This tract can allow some fluid

leeking until it melds back together ...in a spinal tap this typically

happens in the first few hours ( can take a few days /hense spinal headaches

and use of a blood patch when they don't close up . ) ...with that graft the

cyroprecipitate glue seals the tract holes up right away / and typically the

doctor will place a bit of internal presure on the graft so he can check for

a good seal before closing up the incision too .

2. Please forgive me if I have already ask this question, but what

is this cauterizing of the tonsil all about? I am not quite sure on

why it is done.

typically only a small amount of the tonsils tissue would be burned away and

there are several reasons a doctor may recomend this .

....this tissue has NO known purpose ( and no long term impacts being gone )

but is blocking the path of good flow ...and frequently the presure this

tissue has been under will have dammaged it as well leading to NO

signigigant hope that the tissue could recover and become functional again

..

Another reason it may be proposed /done is ...when those tonsils are below

the level of c1 at all ( typically around 12 mm in herniation debth ) then

there is an issue /need to remove part of c2 ( NOT JUST C 1 ) to get the

presure relieved . If burning off a few mm of tissue will avoid this there

are good reasons to consider it too .

Removing part of c2 is known to lead to greater incidence of cervical

instability for example post decompresion ...and there is a greater need for

suport post op ( a rigid collar is usually needed for awhile ) / a greater

degree of discomfort in recovery and slower healing time ...in short a more

complex surgery to carry out / more risks in possible cervical shifting

later

and a slower recovery time ect . can all be avoided with cauterisation in

SOME folks . This won't be true for everyone with those deep herniations but

is for quite a few of them .

Burning it away when dammaged and scared ect made total sense to me .

.....they still don't know of any known functions for it /and those of us

who've had this done havn't had any major problems as a result either .

.....It makes great sense to me as a former nurse ...maybe that comes from

having seen dammaged tissue /scared tissue ect in front of my eyes in other

situations ...but heck such a simple thing to regain better flow ? To me it

seemed best to do ALL that could optimise surgery being sucessful and avoid

the possible need for further surgery .

My neurosurgeon also said that the tonsils will frequently PULL UP some in

responce to the cautery ...he then sews the graft in a way it acts somewhat

like a sling or hammock helping to KEEP them up that bit more too .

Not all neurosurgeons chose to do this ....hense debate umongst US about

what

is better ...they don't typically argue this point themselves much having

experience themselves with using cauterisation in other contexts /uses .

I have heard them say in agreement though that it is a good viable

alturnative to those c2 lamenectomys that more and more they feel is

justified in considering seriously even when they arn't the doctors

ROUTINELY

doing cauterisation . Many reserve this decison until they are inside your

chiari area then may decide based on what they find which is best too .

While on this topic I'll throw in that another reason they may sugest

opening

the dura that we don't discuss often here is ...a signifigant percentage of

us also have some tough bands of tissue at the level of the foramen that

bind

or constrict the tonsils tissue ( I heard one doctor discribe these as sort

of like a rubber band wraped around a few times /twisted to keep them

tightly

constricted ) ...unless these bands are found and removed they may well

hinder good results . They can't be seen on MRI or through the dura ...so

the

doctor must GUESS if they are there ( more typical of acm 2 as I recall but

may be there with acm 1 ) ...or open the dura to be sure . ( it must be

opened to remove these ) .

My nsg also said that occationally he will find something totally

unexpected

when he gets inside too ...he likes to go that slight extra distance and

MAKE

sure he has fully found /addressed someones problems when he's there the

first time KNOWING that if he doesn't go clear to the level of that tonsil

tissue being exposed and MAKING Sure the csf is moving freely - he may well

find himself later going back in to finnish a job that would have much more

easily be addressed the first time for BOTH the patients sake /and reducing

the amount of surgery needed for good results ...again this made great sense

to me .

3. My doctor mentioned something about part of the tonsil (I think

that is the part she said) actually being dead because of being

compressed too long? Has this happened to anyone and are there any

noticeable problems that can't be compensated for by the rest of the

brain?

Usually this would refer to the tonsil tissue as discribed above . ...Folks

who've had the tonsils cauterised recover at the same rate ( or better if

flow is still blocked by having left the tissue there ) . Studies have

looked

at the sucess rate using cautery and found it seems to offer greater

improvements as I recall the discussion at ASAP . NO study has ever

demonstrated any long term harm at all from doing it .

4. Also a question about long hair vs. short hair? What have the

females on here done as to hair length prior to surgery and after? I

have heard two stories, one story for each length. I was just

thinking that long hair might get in the way, and be harder to take

care of.

My hair is waist lenght ...I left it long braided in 4 pigtails the morning

of surgery . The doctor shaved but left the hair braided in ...later I just

brushed it out ( a week later ) ...having braids /parts ment using some

scalp

cleaning sheets wasn't hard to clean away some scalp oil /feel fresher

....and

the long hair covered MOST of the shaved area . ( I had two incsions ..one

made to harvest the graft material ...so about 2/3 of the back of my head

was

shaved . )

Again this is something that will vary from Doctor to Doctor ...by all means

talk to yours about what he feels is best . I got bashed for my offhand

comment last week that I wasn't wanting to debate a topic of my post ...so

I'll leave this wide open and say I'm glad to discuss my understanding of

these issues more ....but I'd sugest ANYONE who can -- consider renting a

couple of the neurosurgeons lectures from ASAP to get this info accuratly

....I tend to forget LOTS of the details they cover in the tapes /and

remember

bits inaccuratly too ...it's a much better source of info. too understand

the

variations between doctors and the details of what they feel works best .

....ASAP's website url is changing ...the new web site is http://ASAP.org .

The lectures are available to rent for $10 a tape ...I'd sugest starting

with

a tape each by Dr Milhorat / Oro / and Batzdorf or Ellenboggen to grasp the

range between assertive and conservative ...there are other approaches as

well /but these are a great starting place . Do consider copying the tapes

while you have them both to later refresh your memory /understanding and to

share with your local care providers .

Hope that helps ...again it's just MY understanding of these Q .

in Paradise

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[Guest guest]

Hmmmmmmmm...Just thought that I would mention my patch material...It might

make some feel more comfortable or confuse the issue entirerly

Mine is made up of a layer of fascia from around my own neck muscles....PLUS

a layer of " Gortex " type material. Knock wood...I have had NO problems and

that was 12 years ago...

TTMOMK part of the leak or not issue, also involves the skill of the surgeon

with stitching.

Best wishes,

Sally R

ACM..Decompression '91...

Hydro..VP shunt..2 revisions

Doing GREAT in Bethlehem,Pa with NO medications

> I had wanted to reply to the group because of the mention of dura patches

> and the substance of them not making a difference.

>

> Dr. Frim in Chicago- a experienced doctor in chiari- does not use

artificial

> dura patches in his surgeries. He has also recently written a paper on

why

> a natural (patch made of your own tissue) should be used and advising

> against the use of artificial patches.

>

> We ended up at Dr. Frim because our daughter did fabulous initially and

then

> ended up getting symptom after symptom slowly return. Her dura patch is

> made of gortex. It has reacted with her body and caused scar tissue

> buildup.

>

> Dr. Frim said that for this very reason he does not use artificial patches

> for his surgeries and has done a paper on such topic.

>