Surgical experience with 2959 allogeneic and xenogeneic dense connective tissue grafts (1767 of fascia lata, 909 of pericardium, and 283 of dura mater), used in 2665 neurosurgical operations performed in the course of 20 years (1976 to 1995) is reported. Duraplasty using either allogeneic or xenogeneic grafts has had a similar, and favourable clinical outcome. Nevertheless, the pliable deep frozen fascia lata grafts, which could be used in any location, have been reserved for sella turcica plugging, anterior cranial base plasty, aneurysmal wrapping, and surgery of lipomyelomeningocele. Pericardium and dura mater grafts were in the majority of cases used over the brain convexity and posterior cranial fossa. Ovine pericardium proved to be superior to bovine and allogeneic pericardia because of its workability, flexibility, reduced thickness, and better transparency. Postsurgical complications occurred in 7.3%, and they were: 1) cerebrospinal fluid fistulas in 2.8%; 2) meningites in 2.3% (aseptic 1.4%, bacterial 0.8%, and tumoural 0.1% meningites); 3) pseudomeningoceles in 2.2%; 4) wound infections in 0.6%; 5) malresorptive hydrocephalus in 0.5%; and 6) adhesions to nerve tissue in 0.5%. The majority of complications healed without surgery. Forty-eight grafts (1.6%) failed to fulfil the requirements of the surgeon, and 46 of them were re-operated upon. Though another thirty-nine grafts healed successfully, 39 shunts (1.5%) had to be performed for malresorptive hydrocephalus (0.9%), and/or for a big pseudomeningocele (0.6%). So, the pure complication rate in 2665 duraplasties was 3.1%. The complex evaluation of the allogeneic and xenogeneic grafts (fascia, pericardium, and dura mater), used for duraplasty in neurosurgery during the last 20 years proved them, as remarkably good, with a success rates of 96.9%.

A case of a catheterobronchial fistula as a rare late complication of a ventriculoatrial shunt is reported. The ventriculoatrial shunt was implanted in a 4-monthold boy suffering from extreme postinfectious hydrocephalus. During the following years, twelfth nerve palsy on the right, vertebralgias, and salty taste sensations in the mouth associated with intermittent coughing and swelling of the neck and supraclavicular region on the right side developed. Valvography established a diagnosis of fistula 12 years after the implantation of a shunt. Ultrasonography of the neck and mediastinum and contrast-enhanced dynamic computed tomographic scanning demonstrated a catheterobronchial fistula to the subsegmental bronchus of the anterior segment of the right upper lung lobe, a thrombosis of the right internal jugular and both right and left brachiocephalic veins and the superior vena cava, and an extensive collateral venous system mainly draining into the azygos vein. Normalization of cerebrospinal fluid and blood flow and pressure allowed extraction of the “atrial” catheter without complications. One year after surgery the boy is in good health and without signs of shunt dependence.

The authors describe cases of external lumbar CSF drainage with a regulated flow inserted lumbally or in the pseudomeningocele in children. During flow regulation during operation they were guided by the finding in the surgical field, during therapeutic use (in the course of 1-8 days) by setting the CSF output at 15 ml/hour. Drainage was used in extradural approach to the orbit, for treatment of liquorrhoea in surgical wounds of the posterior fossa, frontal and temporal drainage to clear the CSF in meningitis and to make inner drainage possible. CSF fistulae healed even after major craniectomies and infections due to the resistance of allogenic and xenogenic dural transplants. For external CSF drainage the authors used lumbar needles, intravenous Portex kits or original Cordis kits. The latter proved to be the best.

The authors describe three cases of operated developmental cysts in the area of the laminae quadrigeminae in children. The performed multiple fenestrations or excision of the wall of the cyst and effective communication with the subarachnoid or ventricular system, as well as a plastic operation of the dura mater with collagen tissue from a Tissue bank. By means of light microscopy the walls of two cysts were examined (one arachnoid and one glioependymal), one cyst was examined by electron microscopy (glioependymal). The authors supplemented by their own cases the number of hitherto described cysts in the collicular region to 56.

A 5-year experience with the glutaraldehyde-stabilized freeze-dried radiation-sterilized calf pericardium used as a dural substitute is reported. The structure of pericardium xenograft is compared with other collagenous materials used for duraplasty (allogeneic fascia lata and dura mater) by light and electron microscopy. The special neurosurgical techniques involved in using pericardium xenografts in the reconstruction of suboccipital dura mater in children are presented in detail.

The authors report their five-year experience with the use of xenogenic calf pericardium for plastic operations of the cerebral and spinal dura mater which they introduced into neurosurgical practice in 1983. Of 165 grafts they selected 50 which they used in children for the plastic operation of the dura mater above the posterior cranial fossa, above the convexity of the brain and at the skull base. The xenogenic pericardium proved successful and resolved also the shortage of allogenic collagenous tissues (fascia lata, dura mater) used for plastic operations of the dura mater. Moreover, due to its resistance it achieved priority in some indications and localizations. When used, certain conditions must be met to ensure satisfactory incorporation (suitable size, intradural submersion, careful suture).