Role of dural tenting sutures in preventing edh in routine surgery

1. ROLE OF DURAL TENTING ROLE OF DURAL TENTING
SUTURES IN PREVENTING SUTURES IN PREVENTING
EDH IN ROUTINE SURGERYEDH IN ROUTINE SURGERY
DEEPAK AGRAWAL, BS SHARMA, VS MEHTADEEPAK AGRAWAL, BS SHARMA, VS MEHTA
Deptt. Of Neurosurgery, AIIMSDeptt. Of Neurosurgery, AIIMS
New DelhiNew Delhi

2. AIIMS 2002AIIMS 2002
Walter Dandy (1932)Walter Dandy (1932)
““A NUMBER OF PERMANENT SILK A NUMBER OF PERMANENT SILK
SUTURES TIGHTLY DRAWN BETWEEN SUTURES TIGHTLY DRAWN BETWEEN
THE DURA AND THE GALEA OR THE DURA AND THE GALEA OR
SUBAPONEUROTIC TISSUE…[WILL] SUBAPONEUROTIC TISSUE…[WILL]
HOLD THE DURA FIRMLY AGAINST HOLD THE DURA FIRMLY AGAINST
THE BONE AND MAKE POSTOP EDH THE BONE AND MAKE POSTOP EDH
FROM THIS SOURCE IMPOSSIBLE”FROM THIS SOURCE IMPOSSIBLE”

3. AIIMS 2002AIIMS 2002
WHAT IS THE NEED OF THIS WHAT IS THE NEED OF THIS
STUDY?STUDY?

4. AIIMS 2002AIIMS 2002
The use of dural tenting sutures today The use of dural tenting sutures today
is a perpetuation of a tradition is a perpetuation of a tradition
introduced 70 years back.introduced 70 years back.
Pts were hypotensivePts were hypotensive
Blood was not replacedBlood was not replaced
Minimal monitoring of cardiovascular Minimal monitoring of cardiovascular
statusstatus

5. AIIMS 2002AIIMS 2002
Era of evidence based medicineEra of evidence based medicine
Conditions like significant systemic Conditions like significant systemic
hypotension almost nonexistentent hypotension almost nonexistentent
nownow
Possibility of causing bleeding from Possibility of causing bleeding from
dural or cerebral vessels is presentdural or cerebral vessels is present
Slightly longer operating timeSlightly longer operating time

6. AIIMS 2002AIIMS 2002
AIM:AIM:
TO ASSESS THE EFFICACY OF DURAL TO ASSESS THE EFFICACY OF DURAL
TENTING SUTURES IN PREVENTING TENTING SUTURES IN PREVENTING
POSTOP EDH FORMATION POSTOP EDH FORMATION
FOLLOWING ELECTIVE FOLLOWING ELECTIVE
SUPRATENTORIAL CRANIOTOMYSUPRATENTORIAL CRANIOTOMY

7. AIIMS 2002AIIMS 2002
MATERIALS AND METHODSMATERIALS AND METHODS
PROSPECTIVE RANDOMISED STUDYPROSPECTIVE RANDOMISED STUDY
JUL 2001 TO JUNE 2002JUL 2001 TO JUNE 2002

8. AIIMS 2002AIIMS 2002
300 PTS
150 PTS
HITCH
150 PTS
NO HITCH
MATERIALS & METHODSMATERIALS & METHODS

9. AIIMS 2002AIIMS 2002
HOWEVER, ALL PTS IN WHICH
THE SURGEON FELT THERE WAS
NEED FOR HITCH SUTURES WERE
EXCLUDED FROM THE STUDY AND
NOT RANDOMISED

10. AIIMS 2002AIIMS 2002
300 pts
150 hitch 150 no hitch
89 M 61 F 78 M 72 F
RESULTS RESULTS (Sex distribution)(Sex distribution)

11. AIIMS 2002AIIMS 2002
0
10
20
30
40
0 TO10
11 TO 2021 TO 3031 TO 4041-5051-6061-7071 TO 80
AGE GROUPS
HITCHNO HITCH

12. AIIMS 2002AIIMS 2002
0
20
40
60
80
100
TUMOR VASCULAR OTHERS
HITCHNO HITCH
TYPE OF SURGERY

13. AIIMS 2002AIIMS 2002
OUTCOMEOUTCOME
1
2
0
2
0
0.5
1
1.5
2
HITCH NO HITCH
POSTOP EDH
OPERATED NOT OPERATED

14. AIIMS 2002AIIMS 2002
CONCLUSIONSCONCLUSIONS
DURAL TENTING SUTURES ARE DURAL TENTING SUTURES ARE
SUPERFLUOUS IN ROUTINE SUPERFLUOUS IN ROUTINE
SUPRATENTENTORIAL CRANIOTOMYSUPRATENTENTORIAL CRANIOTOMY

15. AIIMS 2002AIIMS 2002
THANK YOUTHANK YOU