Average patient age was 46 years (range, 19-70 years). Follow-up was 4.6 years. The expanded
polytetrafluoroethylene sheets were implanted after
decompressive craniectomy or after combined resection of the dura mater and a
tumor. Epidural, but not subdural,
abscesses were found in 6 patients, in whom a sufficient
capsule developed underneath the synthetic dura mater. Both epidural and subdural
abscesses were found in the remaining 6 patients, and the
capsule remained intact after
debridement of the subdural
abscesses in half of them. Secondary cranial reconstruction was safely performed by leaving the
capsule intact in the 9 cases in which no additional dural reconstruction was performed. In the remaining 3 patients, in whom no
capsule remained after
debridement, secondary cranial reconstruction was carried out by leaving the pericranium over the brain surface. None of the patients developed postoperative complications in follow-up periods.
CONCLUSIONS: Staged cranial reconstruction after the removal of an infected synthetic dura mater substitute using an algorithmic approach is feasible and safe, produces satisfactory cosmetic results, and is not associated with any complications.