Limits...
Evaluation of efficacy and biocompatibility of a novel semisynthetic collagen matrix as a dural onlay graft in a large animal model.

Neulen A, Gutenberg A, Takács I, Wéber G, Wegmann J, Schulz-Schaeffer W, Giese A - Acta Neurochir (Wien) (2011)

Bottom Line: BCM and DuraGen™ showed superior handling than periosteum with a trend for better adhesion to dura and CSF tightness for BCM.Duraplasty time with periosteum was significantly higher (14.4 ± 2.7 min) compared with BCM (2.8 ± 0.8 min) or DuraGen™ (3.0 ± 0.5 min).BCM and DuraGen™ showed a trend for an enhanced lymphocytic reaction of the brain parenchyma compared with periosteum.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Center of Neurological Medicine, University of Göttingen, Germany. axel.neulen@unimedizin-mainz.de

ABSTRACT

Background: Semisynthetic collagen matrices are promising duraplasty grafts with low risk of cerebrospinal fluid (CSF) fistulas, good tissue integration and minor foreign body reaction. The present study investigates the efficacy and biocompatibility of a novel semisynthetic bilayered collagen matrix (BCM, B. Braun Aesculap) as dural onlay graft for duraplasty.

Methods: Thirty-four pigs underwent osteoclastic trepanation, excision of the dura, and placement of a cortical defect, followed by duraplasty using BCM, Suturable DuraGen™ (Integra Neuroscience), or periosteum. CSF tightness and intraoperative handling of the grafts were evaluated. Pigs were sacrificed after 1 and 6 months for histological analysis.

Findings: BCM and DuraGen™ showed superior handling than periosteum with a trend for better adhesion to dura and CSF tightness for BCM. Periosteum, which was sutured unlike the synthetic grafts, had the highest intraoperative CSF tightness. Duraplasty time with periosteum was significantly higher (14.4 ± 2.7 min) compared with BCM (2.8 ± 0.8 min) or DuraGen™ (3.0 ± 0.5 min). Tissue integration by fibroblast infiltration was observed after 1 month for all devices. More adhesions between graft and cortex were observed with DuraGen™ compared with BCM and periosteum. No relevant adhesions between leptomeninges and BCM were observed and all devices showed comparable lymphocytic reaction of the brain. All devices were completely integrated after 6 months. BCM and DuraGen™ showed a trend for an enhanced lymphocytic reaction of the brain parenchyma compared with periosteum. Implant rejection was not observed.

Conclusion: Semisythetic collagen matrices are an attractive alternative in duraplasty due to their easy handling, lower surgical time, and high biocompatibility.

Show MeSH

Related in: MedlinePlus

Surgical procedure. a Semisynthetic collagen matrices BCM (i) and DuraGen™ (ii) are shown. b illustrates the experimental approach: after creation of the osteoclastic defect, a dural defect and cortical lesion were created. After haemostasis, the dural defect was closed using an onlay graft (i). The intracranial pressure was monitored ((ii). c shows dural defects closed with periosteum (i), BCM (ii), and DuraGen™ (iii)
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3197932&req=5

Fig1: Surgical procedure. a Semisynthetic collagen matrices BCM (i) and DuraGen™ (ii) are shown. b illustrates the experimental approach: after creation of the osteoclastic defect, a dural defect and cortical lesion were created. After haemostasis, the dural defect was closed using an onlay graft (i). The intracranial pressure was monitored ((ii). c shows dural defects closed with periosteum (i), BCM (ii), and DuraGen™ (iii)

Mentions: Animals were transferred to the prone position. After disinfection, a midline incision of the scalp was made and the periosteum was exposed. In animals selected for dural reconstruction with periosteum, a 2 × 2-cm sheet of periosteum was harvested and kept in a humidified chamber. A 4-mm drill hole was made in the right frontal region and an intracranial pressure probe (Codman ICP Monitoring System, Codman, Le Locle, Switzerland) was implanted into the right frontal white matter (Fig. 1). An osteoclastic craniotomy (2.5 × 2 cm) was performed in the left parietal region and a dural defect (1.5 × 1 cm) was created using surgical microscissors. A cortical defect (2–3 mm diameter) was made using mild suction (Fig. 1). Haemostasis was achieved where needed using Sangustop™ (B. Braun Aesculap, Tuttlingen, Germany). All foreign materials were removed before dural reconstruction. The galea was closed using Safil™ USP 2/0 (B. Braun Aesculap) and skin closure was done using Dafilon™ USP 2/0 (B. Braun Aesculap). Questionnaires evaluating workability, cutting behaviour, stiffness/flexibility, stability in a wet environment, watertightness and adhesion to dura were completed immediately after wound closure for each procedure. The following scoring was used: 1 = very good, 2 = good, 3 = acceptable, 4 = poor, 5 = not acceptable. Furthermore stickiness to instruments and gloves were evaluated as: 1 = without any problem, 2 = acceptable, 3 = not acceptable.Fig. 1


Evaluation of efficacy and biocompatibility of a novel semisynthetic collagen matrix as a dural onlay graft in a large animal model.

Neulen A, Gutenberg A, Takács I, Wéber G, Wegmann J, Schulz-Schaeffer W, Giese A - Acta Neurochir (Wien) (2011)

Surgical procedure. a Semisynthetic collagen matrices BCM (i) and DuraGen™ (ii) are shown. b illustrates the experimental approach: after creation of the osteoclastic defect, a dural defect and cortical lesion were created. After haemostasis, the dural defect was closed using an onlay graft (i). The intracranial pressure was monitored ((ii). c shows dural defects closed with periosteum (i), BCM (ii), and DuraGen™ (iii)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3197932&req=5

Fig1: Surgical procedure. a Semisynthetic collagen matrices BCM (i) and DuraGen™ (ii) are shown. b illustrates the experimental approach: after creation of the osteoclastic defect, a dural defect and cortical lesion were created. After haemostasis, the dural defect was closed using an onlay graft (i). The intracranial pressure was monitored ((ii). c shows dural defects closed with periosteum (i), BCM (ii), and DuraGen™ (iii)
Mentions: Animals were transferred to the prone position. After disinfection, a midline incision of the scalp was made and the periosteum was exposed. In animals selected for dural reconstruction with periosteum, a 2 × 2-cm sheet of periosteum was harvested and kept in a humidified chamber. A 4-mm drill hole was made in the right frontal region and an intracranial pressure probe (Codman ICP Monitoring System, Codman, Le Locle, Switzerland) was implanted into the right frontal white matter (Fig. 1). An osteoclastic craniotomy (2.5 × 2 cm) was performed in the left parietal region and a dural defect (1.5 × 1 cm) was created using surgical microscissors. A cortical defect (2–3 mm diameter) was made using mild suction (Fig. 1). Haemostasis was achieved where needed using Sangustop™ (B. Braun Aesculap, Tuttlingen, Germany). All foreign materials were removed before dural reconstruction. The galea was closed using Safil™ USP 2/0 (B. Braun Aesculap) and skin closure was done using Dafilon™ USP 2/0 (B. Braun Aesculap). Questionnaires evaluating workability, cutting behaviour, stiffness/flexibility, stability in a wet environment, watertightness and adhesion to dura were completed immediately after wound closure for each procedure. The following scoring was used: 1 = very good, 2 = good, 3 = acceptable, 4 = poor, 5 = not acceptable. Furthermore stickiness to instruments and gloves were evaluated as: 1 = without any problem, 2 = acceptable, 3 = not acceptable.Fig. 1

Bottom Line: BCM and DuraGen™ showed superior handling than periosteum with a trend for better adhesion to dura and CSF tightness for BCM.Duraplasty time with periosteum was significantly higher (14.4 ± 2.7 min) compared with BCM (2.8 ± 0.8 min) or DuraGen™ (3.0 ± 0.5 min).BCM and DuraGen™ showed a trend for an enhanced lymphocytic reaction of the brain parenchyma compared with periosteum.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Center of Neurological Medicine, University of Göttingen, Germany. axel.neulen@unimedizin-mainz.de

ABSTRACT

Background: Semisynthetic collagen matrices are promising duraplasty grafts with low risk of cerebrospinal fluid (CSF) fistulas, good tissue integration and minor foreign body reaction. The present study investigates the efficacy and biocompatibility of a novel semisynthetic bilayered collagen matrix (BCM, B. Braun Aesculap) as dural onlay graft for duraplasty.

Methods: Thirty-four pigs underwent osteoclastic trepanation, excision of the dura, and placement of a cortical defect, followed by duraplasty using BCM, Suturable DuraGen™ (Integra Neuroscience), or periosteum. CSF tightness and intraoperative handling of the grafts were evaluated. Pigs were sacrificed after 1 and 6 months for histological analysis.

Findings: BCM and DuraGen™ showed superior handling than periosteum with a trend for better adhesion to dura and CSF tightness for BCM. Periosteum, which was sutured unlike the synthetic grafts, had the highest intraoperative CSF tightness. Duraplasty time with periosteum was significantly higher (14.4 ± 2.7 min) compared with BCM (2.8 ± 0.8 min) or DuraGen™ (3.0 ± 0.5 min). Tissue integration by fibroblast infiltration was observed after 1 month for all devices. More adhesions between graft and cortex were observed with DuraGen™ compared with BCM and periosteum. No relevant adhesions between leptomeninges and BCM were observed and all devices showed comparable lymphocytic reaction of the brain. All devices were completely integrated after 6 months. BCM and DuraGen™ showed a trend for an enhanced lymphocytic reaction of the brain parenchyma compared with periosteum. Implant rejection was not observed.

Conclusion: Semisythetic collagen matrices are an attractive alternative in duraplasty due to their easy handling, lower surgical time, and high biocompatibility.

Show MeSH
Related in: MedlinePlus