Lyophilized Human Dura Mater as a Dural Substitute

Efficacy and Safety of Ethylene Oxide Sterilization of Allogeneic Bone for Human Transplantation: A Forty-year Experience

“…In the four decades after the discovery of its bacteriocidal effect during which EO was used as an industrial fumigant, the toxic effects of this substance and its reaction products in tissue, ethylene chlorohydrin (EC), and ethylene glycol (EG), were reported in organs and tissues [11,[21][22][23][24][25][26]. By the mid-1970s, sporadic papers had reported the use of EO in the sterilization of bone and dura mater, but no studies had validated its diffusion into and out of tissues, nor had demonstrated its effectiveness in destroying surface and interstitial microorganisms, nor had reported the removal of EO, EC, and EG toxic residues after tissue processing [14][15][16][17][27][28][29].…”

Freeze-Dried Cadaveric Dural Grafts Can Stimulate a Damaging Immune Response in the Host

“…An infection related to the oper ation, or a 'chemical' response to the graft would surely have been manifest much sooner after the operation. An immune reac tion of this kind would appear to be an unusual occurrence as large series of such grafts have been reported in which the only complication seems to have been infection [2][3][4][5][6][7][8], Animal work has suggested that the graft is fairly rapidly replaced by host dural tissue [3,6,7,10,14], and that even dura mater that is not lyophilised does not pro voke a significant immune response [9], Some workers have suggested that the freeze drying process renders the tissue inert [5,15], and experimental work has suggested that repeated application of freeze-dried skin grafts does not lead to sensitisation [11][12][13]. In clinical practice, these grafts are well toler ated even in sites which are readily accessible to immunocompetent cells.…”

A new technique of dural closure ? experience with a vicryl mesh

“…In between, different types of dural substitutes have been used including metallic foils [3,19], nonviable membranes, e.g. amniotic membranes [18], autologous grafts such as temporalis fascia, pericranium or fascia lata [22], homologous grafts like freeze-dried and lyophilised dura [21], heterologous materials such as porcine dermis [15] or silastic coated Dacron [2,16]. In the late seventies, Vicryl (polyglactin 910) was more often used as suture material [7] causing only minimal inflammatory reaction in non-neural tissue.…”