Effects of Radiation on Spinal Dura Mater and Surrounding Tissue in Mice

Yokogawa, Noriaki; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Yoshioka, Katsuhito; Yamamoto, Miyuki; Iseki, Shoichi

doi:10.1371/journal.pone.0133806

Cited by 16 publications

(14 citation statements)

References 44 publications

(45 reference statements)

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“…However, experimental studies on radiation-induced normal tissue reactions have been widely conducted, leading to important findings applicable to humans. 14,19,20 Thus, we believe the results of this study would contribute to the elucidation of the radiation effects on human vertebrae. The bone quality regulated by the structural and material characteristics could not be evaluated.…”

Section: Discussionmentioning

confidence: 74%

Effects of Radiation on the Bone Strength of Spinal Vertebrae in Rats

Igarashi

Demura

Kato

et al. 2021

Spine

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Study Design. A controlled laboratory study.Objective. The aim of this study was to examine bone damage caused by irradiation to spinal vertebrae in rats. Summary of Background Data. Radiotherapy is widely used in the treatment of malignant spine tumors. However, a few studies have reported vertebral fractures following radiotherapy as an adverse reaction. There are no reports on irradiationinduced changes in bone fragility, mechanical and structural changes focusing on the spine, and the mechanism of irradiation-induced bone osteoporosis. Methods. Eighty-four female Wistar rats were randomly allocated to the 20 Gy irradiated or the nonirradiated (control) group. The lumbar vertebrae were irradiated with an external focal radiation dose of 20 Gy. Biomechanical, structural, and histological analyses were performed at 0, 2, 4, 6, 8, 12, and 24 weeks after irradiation. Structural analysis and bone density measurement of vertebral trabecular bone were performed by mCT. Histopathological evaluation was performed by hematoxylin and eosin staining and immunostaining. Results. The bone strength at 2 weeks after irradiation (311 AE 23 N) was 22% lower than that before irradiation (398 AE 34 N) (P < 0.05). The trabecular spacing increased, and trabecular connectivity and width decreased significantly in the irradiated group compared with those in the non-irradiated group. The three-dimensional structure model became coarse, and the trabecular structure continued to thin and disrupt after irradia-tion. There was no significant change in the bone mineral density in both groups. Conclusion. A decrease in bone strength was observed 2 weeks after irradiation. Bone mineral density remained unaltered, whereas the microstructure of trabecular bone changed, suggesting bone damage by irradiation.

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Section: Discussionmentioning

confidence: 74%

Effects of Radiation on the Bone Strength of Spinal Vertebrae in Rats

Igarashi

Demura

Kato

et al. 2021

Spine

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“…Dural tear repairs are challenging, however, those with friable dura create a particular issue. 8 A watertight closure is required to avoid debilitating headaches and other complications. 6 For patients with especially friable or absent dura, closure with the use of sutures or glue may be ineffective.…”

Section: Discussionmentioning

confidence: 99%

“… 7 However, in some cases, the edges of the native dura may be so friable that suturing or clipping to the dura results in incomplete seals, tears, or leaks through the suture holes. 4 , 8 Additionally, those with a history of radiotherapy to or near the spine may have compromised dural blood supply, extensive scarring or adhesions, and/or tissue hypoxia, thereby weakening the dura mater, increasing the likelihood of CSF leaks, and requiring a more intensive dural closure. 4 , 8 Thus, this study presents a novel approach to treating a radiation-induced dural injury and CSF leak as well as expansive dural tears by the use of a two-layer intradural and extradural patch graft.…”

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confidence: 99%

A novel two-layer, intradural and extradural patch graft approach to treating dural defects and tears: illustrative case

Lazarus

Hawks

Kumar

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Dural tears must be quickly addressed to avoid the development of positional headaches and pseudomeningoceles, among other complications. However, sizeable areas of friable or absent dura create unique challenges when attempting to achieve a watertight seal. We have developed a two-layer subdural and epidural fibrous patch technique to treat expansive or challenging dural tears as a result of our experience treating spinal fluid leaks. OBSERVATIONS The authors present the treatment of a large necrotic (5 × 1.5 cm) dural defect refractory to initial attempts at standard primary repair with dural patch grafting and requiring a revision with a dual-layer patch to manage persistent cerebrospinal fluid leakage. LESSONS The use of a two-layer (subdural and epidural) patch is both a safe and effective dural repair technique for creating a watertight seal in challenging large areas in which the dura may be damaged, scarred, or absent. We also propose that this technique may be able to be used for smaller challenging tears, as well as potentially for repairs of large blood vessels or other fluid-filled structures in the body.

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“…Postoperative CSF leak is a well-known and frequent complication after cranial surgery with a prevalence of 3-11% ( 30 , 31 ). Inadequate dura closure as well as increased CSF pressure can contribute to CSF leaks, and postoperative radiation and chemotherapy may also play a role by preventing adequate dural regrowth ( 32 , 33 ). In this study, 9.9% (72 out of 726) of patients had a CSF leak, consistent with previous reports ( 30 , 31 , 34 ).…”

Section: Discussionmentioning

confidence: 99%

Postoperative communicating hydrocephalus following glioblastoma resection: Incidence, timing and risk factors

et al. 2022

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IntroductionGlioblastoma (GBM) is the most common malignant primary brain tumor. Treatment includes maximally safe surgical resection followed by radiation and/or chemotherapy. However, resection can lead to ventricular opening, potentially increasing the risk for development of communicating hydrocephalus (CH). Complications such as rebleeding and infection may also lead to CH and, eventually, the need for cerebrospinal fluid (CSF) diversion surgery. In this study, we evaluated the incidence of different types of hydrocephalus and potential risk factors for the development of CH following glioblastoma resection.Methods726 GBM patients who underwent tumor resection at our department between 2006 and 2019 were analyzed retrospectively. Potential risk factors that were determined for each patient were age, sex, tumor location, the number of resection surgeries, ventricular opening during resection, postoperative CSF leak, ventriculitis, and rebleeding. Uni- as well as multivariate analyses were performed to identify associations with CH and independent risk factors.Results55 patients (7.6%) needed CSF diversion surgery (implantation of a ventriculoperitoneal or ventriculoatrial shunt) following resection surgery. 47 patients (6.5%) had CH, on median, 24 days after the last resection (interquartile range: 17-52 days). 3 patients had obstructive hydrocephalus (OH) and 5 patients had other CSF circulation disorders. Ventricular opening (odds ratio (OR): 7.9; p=0.000807), ventriculitis (OR 3.3; p=0.000754), and CSF leak (OR 2.3; p=0.028938) were identified as significant independent risk factors for the development of post-resection CH. Having more than one resection surgery was associated with CH as well (OR 2.1; p=0.0128), and frontal tumors were more likely to develop CH (OR 2.4; p=0.00275), while temporal tumors were less likely (OR 0.41; p=0.0158); However, none of those were independent risk factors. Age, sex, or rebleeding were not associated with postoperative CH.ConclusionPostoperative CH requiring CSF shunting is not infrequent following GBM resection and is influenced by surgery-related factors. It typically occurs several weeks after resection. If multiple risk factors are present, one should discuss the possibility of postoperative CH with the patient and maybe even consider pre-emptive shunt implantation to avoid interruption of adjuvant tumor therapy. The incidence of CH requiring shunting in GBM patients could rise in the future.

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Effects of Radiation on Spinal Dura Mater and Surrounding Tissue in Mice

Cited by 16 publications

References 44 publications

Effects of Radiation on the Bone Strength of Spinal Vertebrae in Rats

Effects of Radiation on the Bone Strength of Spinal Vertebrae in Rats

A novel two-layer, intradural and extradural patch graft approach to treating dural defects and tears: illustrative case

Postoperative communicating hydrocephalus following glioblastoma resection: Incidence, timing and risk factors

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