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CORRESPONDENCE
Year : 2019  |  Volume : 67  |  Issue : 3  |  Page : 946--947

Intracranial migrating bone dust

Sunil Pandya 
 Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India

Correspondence Address:
Dr. Sunil Pandya
Department of Neurosurgery, Jaslok Hospital and Research Centre, Dr. G. V. Deshmukh Marg, Mumbai, Maharashtra
India




How to cite this article:
Pandya S. Intracranial migrating bone dust.Neurol India 2019;67:946-947


How to cite this URL:
Pandya S. Intracranial migrating bone dust. Neurol India [serial online] 2019 [cited 2020 Jul 6 ];67:946-947
Available from: http://www.neurologyindia.com/text.asp?2019/67/3/946/263221


Full Text



Kindly refer to the article “Intracranial migrating bone dust: innocuous or evil” (Neurology India 2019;67:534-6).[1]

Jaiswal et al., rightly highlight the need to prevent the entry of microorganisms into the operative field during surgery. Indeed, the entire edifice of aseptic surgery rests on precautions against such entry of germs.

They have provided a succinct and graphic account of a patient who developed a postoperative epidural collection of pus with granulation tissue around particles of bone dust. They have collected 34 cases of similar infection from the literature. Of these, the huge number from a center in Korea is striking.

While there can be no discussion on the need to do all that is possible to prevent infection, especially when a free bone flap has been replaced and when bone dust has been used as plugs to close the defects produced by burr holes along the edge of the craniotomy, I would like to narrate examples based on diametrically opposite approaches used successfully by two eminent surgeons.

Professor Valentine Logue,[2] chief of neurosurgery at the Institute of Neurology at Queen Square (as it was then called), London, England, from 1965 to 1977, used a sterilized vacuum cleaner to suck away all bone dust from the operative field after dural closure. He believed that bone dust was a potent source of infection. It was a fascinating sight, the sterilized tube snaking down from the operation table to the large, floor-mounted vacuum cleaner. Once the dura had been closed, the tip of the tube from the vacuum cleaner was handed over to him by the theater sister. At his command, the cleaner would be switched on. The tip was carefully and gently moved over every centimeter of the operative field. Once he was satisfied that no speck of bone dust remained, the vacuum cleaner was discarded and the field irrigated using iodinated saline.

Dr. M. Sambasivan,[3] professor of neurosurgery at the Trivandrum Medical College and Hospital, on the other hand, extolled the virtues of bone dust. When I visited him in 1969, eager to learn, among other things, his experiences with intracranial aneurysms, he bubbled with enthusiasm in his operation theater about the efficacy of bone dust in stopping troublesome oozing of blood from the brain. During surgery, he proved to me that oozing from capillaries and even venules could be stopped by covering them with bone dust and keeping gentle pressure over them using a cottonoid. You must remember that those were the days when oxidized cellulose (Oxycel ®) was just not available and even obtaining gelatin sponge (Gelfoam ®) in public sector teaching hospitals was difficult.

I recall looking up the literature then for experiences in controlling bleeding using bone dust and failed to find any. I cannot recall how Dr. Sambasivan developed his practice of using it thus.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Jaiswal PA, Vilanilam GC, Rajalakshmi P, Kumar KK, Abraham M. Intracranial migrating bone dust: Innocuous or evil? Neurol India 2019;67:534-6.
2Anonymous: Valentine Logue (1913-2000). Available from: http://www.societyns.org/society/bio.aspx?MemberID=20271. [Last accessed on 2019 May 29].
3Nair K. Rajasekharan: Prof. M. Sambasivan (1936-2018). Obituary. Neurol India 2018;66:1222-6.