Hemorrhagic Complications in Association with Silastic Dural Substitute: Pediatric and Adult Case Reports with a Review of the Literature

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Abstract
Delayed intracranial hemorrhage is an unusual complication associated with the use of silastic dural substitute. We present three patients with this complication. Two adult patients developed subdural and epidural hemorrhages 9 months and 10 years after posterior fossa surgery for Chiari malformations. The remaining patient, a 13-month-old child, is the youngest reported patient to develop an epidural hematoma 8 months after a craniosynostosis repair. The hematomas were removed with the silastic dural substitute from all three patients, and the dural defect was repaired with autologous paracervical fascia. Silastic dural grafts have an increased incidence of hemorrhage associated with their use. A slight increase in the prevalence of hemorrhagic complications with silastic dural substitute was observed in women. We report our radiographic and surgical findings, including an extensive review of the literature.