Dural Repair in Cranial Surgery Is Associated with Moderate Rates of Complications with Both Autologous and Nonautologous Dural Substitutes

Azzam, Daniel; Yang, Isaac; Nguyen, Thien; Sheppard, John P.; Alkhalid, Yasmine; Lagman, Carlito; Prashant, Giyarpuram N.

doi:10.1016/j.wneu.2018.01.115

Cited by 47 publications

(26 citation statements)

References 53 publications

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“…In a recent article, it was determined that the most common indication for duraplasty was tumor resection (53% cases) which was covered using synthetic grafts. 8 Another included Arnold-Chiari malformations, which was managed commonly by allografts, and removal of subdural hematomas after TBI which were covered by xenografts. The pitfall in the review article was that the use of autografts was not assessed because of the evidence that pericranium has poor handling properties (being thin and fragile), harvesting it entails more time, material harvested is less to cover large gaps, and larger incidence of CSF fistulas, aseptic meningitis, and implant failures.…”

Section: Discussionmentioning

confidence: 99%

A Randomised Interventional Study to Compare Autologous and Nonautologous Dural Substitutes Among Traumatic Brain Injury Patients

Pandit

Sharma

Bhaskar³

et al. 2020

Indian Journal of Neurotrauma

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Objectives To determine and compare the effectiveness and safety of galea-pericranium autologous dural graft with nonautologous polypropylene (G-patch) dural substitute among traumatic brain injury (TBI) patients. Methods A prospective interventional randomized comparative study was conducted at the Department of Neurosurgery from November 2013 to March 2015 after obtaining approval from the Institutional Ethical Committee. The study population included 50 cases of TBI which were divided into two groups of 25 each by the randomization technique and were treated either with autologous duraplasty (galea-pericranium) or nonautologous polypropylene (G-patch) dural substitute. The outcomes measured were time to duraplasty, blood loss, hospital stay, and the incidence of complications with the two techniques. The data were entered in a MS Excel spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A p value of < 0.05 was considered statistically significant. Results The average time to harvest galea-pericranium was 5 minutes. Compared with the patients undergoing G-patch, the patients in group pericranium had comparable duraplasty time (minutes) (34.32 vs. 27.80, p = 0.44), significantly lower drain output (54.8 vs. 74.5, p = 0.017), comparable blood loss (322 vs. 308, p = 0.545), comparable blood transfusion (24% vs. 16%, p = 0.48), significantly lesser duration of hospital stay (8.6 vs. 10.44, p = 0.028), comparable wound infection (8% vs. 16%, p = 0.384), and comparable cerebrospinal fluid (CSF) leak (0% vs. 8%, p = 0.149). Conclusion The study showed that galea-pericranium and polypropylene dural patch are equally effective and safe dural substitutes in providing a dural seal to minimize the CSF leaks and infections among posttraumatic brain injury patients.

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Section: Discussionmentioning

confidence: 99%

A Randomised Interventional Study to Compare Autologous and Nonautologous Dural Substitutes Among Traumatic Brain Injury Patients

Pandit

Sharma

Bhaskar³

et al. 2020

Indian Journal of Neurotrauma

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“…The use of porcine, bovine, equine, and other animal tissues to prepare dural substitutes has a history of more than 100 years, and this type of artificial dura mater is the most commonly used in clinics at present [29]. On the basis of their preparation methods, these types of dural substitutes can be divided into two subtypes: one that keeps the original morphology of animal tissues and a second that is prepared using extracted animal collagen.…”

Section: Xenogeneic Materialsmentioning

confidence: 99%

Research and application progress on dural substitutes

Wang¹,

Ao²

2019

Journal of Neurorestoratology

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Dural defects are a common problem in clinical practice, and various types of dural substitutes have been used to deal with dural defects. These play an important role in dural repair. Dural substitutes have gradually reached researchers, neurosurgeons, and patients for approval. This article summarizes the structural characteristics of the dura mater and its regeneration after injury, and reviews the state of progress in research and application. It will provide a reference for the development and application of dural substitutes.

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“…Duraplasty with allograft substituents may have moderate complications after implantation. 9 A promising alternative to traditional autografts involves implanting a suitable substrate to act as an artificial dura to preserve the spinal cord after surgery. Due to the special condition following SCI, the desired dura substitute for duraplasty should meet the following criteria: (i) use certain mechanical properties to improve cerebrospinal fluid flow by limiting meningeal fibrosis, (ii) reduce microgliosis and astrogliosis, and (iii) inhibit the polarization of macrophage accumulation and attenuate progressive secondary injury.…”

Section: Introductionmentioning

confidence: 99%

Duraplasty of PHBV/PLA/Col membranes promotes axonal regeneration by inhibiting NLRP3 complex and M1 macrophage polarization in rats with spinal cord injury

Zhao

et al. 2020

FASEB j.

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Duraplasty after decompression decreases the lesion size and scar formation, promoting better functional recovery, but the underlying mechanism has not been clarified. Here, we fabricated a series of poly(hydroxybutyrate‐co‐hydroxyvalerate)/polylactic acid/collagen (PHBV/PLA/Col) membranes and cultured them with VSC4.1 motor neurons. The material characteristics and in vitro biological characteristics were evaluated. In the subcutaneous implantation test, PHBV/PLA/COl scaffolds supported the cellular infiltration, microvasculature formation, and decreased CD86‐positive macrophage aggregation. Following contusion spinal cord injury at T10 in Sprague‐Dawley rats, durotomy was performed with allograft dura mater or PHBV/PLA or PHBV/PLA/Col membranes. At 3 days post‐injury, Western blot assay showed decreased the expression of the NLRP3, ASC, cleaved‐caspase‐1, IL‐1β, TNF‐α, and CD86 expression but increased the expression of CD206. Immunofluorescence demonstrated that duraplasty with PHBV/PLA/Col membranes reduced the infiltration of CD86‐positive macrophages in the lesion site, decreased the glial fibrillary acidic protein expression, and increased the expression of NF‐200. Moreover, duraplasty with PHBV/PLA/Col membranes improved locomotor functional recovery at 8 weeks post‐injury. Thus, duraplasty with PHBV/PLA/Col membranes decreased the glial scar formation and promoted axon growth by inhibiting inflammasome activation and modulating macrophage polarization in acute spinal cord injury.

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Dural Repair in Cranial Surgery Is Associated with Moderate Rates of Complications with Both Autologous and Nonautologous Dural Substitutes

Cited by 47 publications

References 53 publications

A Randomised Interventional Study to Compare Autologous and Nonautologous Dural Substitutes Among Traumatic Brain Injury Patients

A Randomised Interventional Study to Compare Autologous and Nonautologous Dural Substitutes Among Traumatic Brain Injury Patients

Research and application progress on dural substitutes

Duraplasty of PHBV/PLA/Col membranes promotes axonal regeneration by inhibiting NLRP3 complex and M1 macrophage polarization in rats with spinal cord injury

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