Artikel
Equine collagen foil as dura mater substitute in neurosurgery
Suche in Medline nach
Autoren
-
G. di Nuzzo
- Dipartimento di Neurochirurgia, Seconda Università di Napoli
-
R. S. Parlato
- Dipartimento di Neurochirurgia, Seconda Università di Napoli
-
M. Luongo
- Dipartimento di Neurochirurgia, Seconda Università di Napoli
-
C. Parlato
- Dipartimento di Neurochirurgia, Seconda Università di Napoli
-
A. Moraci
- Dipartimento di Neurochirurgia, Seconda Università di Napoli
| Veröffentlicht: | 30. Mai 2008 |
|---|
Gliederung
Text
Objective: Aim of this study is evaluation of early and long-term results of patients treated by equine collagen foil as dura mater substitute in neurosurgery. We have performed sutureless dural reconstruction, removing tumors in supratentorial and infratentorial region.
Methods: This collagen biomatrix allows the repair and the regeneration of dural defects. We have performed dural reconstruction in 21 patients: 15 tumors (7 cases in parieto-occipital paramedian region and 8 cases in fronto-parietal region) 1 acoustic neurinoma, 2 Chiari I malformation, 1 severe head injury and 2 spinal tumors.
Results: We did not use surgical dural suture in any patients. Clinical findings were normal and we did not observe signs of graft rejection and any formation of cerebrospinal fluid fistulae. In particular, the dural reconstruction in posterior cranial fossa has been easy and fast, without surgical dural sutures. We have performed MR at 1 week and 1 mouth after surgery. At follow-up we have not observed postoperative CSF leakage. In one case of atypical meningioma, we performed reoperation after 1 year. We observed no adherences between brain and neodura which is normal regenerated dura, as you can see in intraoperative video, histopatological and ultrastructural examination.
Conclusions: Ideal dural substitute should be elastic, biologically non-reactive, and free from development of adhesion. Among the other dural substitutes, biodegradable materials have variable degradation rates and may not persist in vivo long enough to allow dural regeneration. Autografts available for graft are inadequate when the defect is large. In addition, hypoxia of the autograft can induce inflammatory reactions in the underlying cortex. The needle hole created during suturing is sometimes large enough to produce CSF leakage. Tissudura has all carateristics of ideal dura substitute: elasticity, non reactivity, good adaptability and it is also very easy to handle, so the application is easy, fast and safe, avoiding sutures.
