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59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Equine collagen foil as dura mater substitute in neurosurgery

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  • corresponding author 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

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP 025

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc293.shtml

Published: May 30, 2008

© 2008 di Nuzzo et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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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.