CASE REPORT Unusual dural substitute complications in pediatric patients Arash Esmaeili & Farideh Nejat & Mohsen Nouri & Maryam Monajemzadeh & Mostafa El Khashab Received: 31 August 2011 / Accepted: 2 January 2012 / Published online: 14 January 2012 # Springer-Verlag 2012 Introduction The repair of large cranial or spinal dural defects has espe- cially been a challenge faced by most neurosurgeons. Repair of dural defects is essential to avoid complications such as permanent cerebrospinal fluid (CSF) leakage, infection, neural herniation and adhesions between neural and overlying tissues [4]. Large dural defects are usually repaired with either au- tologous graft materials (e.g., periosteum, fascia) or artificial tissues. Using biological graft harvested from the patient takes more time compared to using synthetic graft. Most often the fascia is taken from the same operative field or from distant sites. Silastic membranes are some of the most commonly used dural substitutes whose material is easily fashioned to an appropriate size and shape. They bear no risk of transmissible disease and more importantly, react minimally with adjacent neural tissues [5]. However, the use of silastic dural grafts has potential risks for the recipients. In this article, we report two unusual complications related to dural substitutes in pediatric patients and review the current literature. Case reports Case 1 A 7-year-old girl was operated on for posterior fossa midline pilocytic astrocytoma. Regular follow-up magnetic reso- nance imaging (MRI) scans were free of tumor recurrence. Two years after surgery, she was admitted with sudden headache and vomiting. Brain computed tomography (CT) scan revealed hemorrhage inside the previously cystic area of dilated fourth ventricle adjacent to dura mater of posterior fossa surgery (Fig. 1). Brain MRI with and without gado- linium could not show any tumor or vascular lesion in the posterior fossa. She had three more attacks in 4 weeks associated with symptomatic hydrocephalus and increased size of the hematoma. Her hydrocephalus was managed with external ventricular drainage and then ventriculo-peritoneal shunting. Brain MR angiography and digital subtraction angiography (carotid and both vertebral arteries, selective external carotid angiography) could not show any abnormal vascular lesion. Surgical exploration with opening the pre- vious posterior fossa craniectomy was performed. Dural patch (PATCH BIOMESH®) was attached to the cerebellum at the left side with small abnormal vessels that were cau- terized. The synthetic graft was removed and dural defect was repaired with patch graft harvested from cervical fascia. Cavity of fourth ventricle was explored which contained hematoma in different age without any abnormal vessels A. Esmaeili : F. Nejat (*) Department of Neurosurgery, Children’ s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran e-mail: nejat@sina.tums.ac.ir M. Nouri Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran M. Monajemzadeh Department of Pathology, Children’ s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran M. El Khashab Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, USA Childs Nerv Syst (2012) 28:485–487 DOI 10.1007/s00381-012-1679-y