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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.

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Related in: MedlinePlus

Intraoperative handling, CSF tightness, time for duraplasty. a Scores evaluated after surgical procedures (see “Materials and methods”). b CSF tightness was similar between the devices with best CSF tightness of periosteum. c Time required for closure of the dura mater was significantly lower with BCM and DuraGen™ compared with periosteum
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Fig2: Intraoperative handling, CSF tightness, time for duraplasty. a Scores evaluated after surgical procedures (see “Materials and methods”). b CSF tightness was similar between the devices with best CSF tightness of periosteum. c Time required for closure of the dura mater was significantly lower with BCM and DuraGen™ compared with periosteum

Mentions: Table 1 and Fig. 2 summarize the results of the questionnaires completed after wound closure to evaluate device handling. Results for both onlay grafts were similar, with a trend for better adhesion to dura and higher CSF tightness for BCM. Workability of the onlay grafts was better compared with periosteum. However, periosteum yielded higher watertightness. This is supported by the CSF tightness measurements, which revealed CSF tightness at higher ICPs for duraplasty with periosteum compared with BCM (12.3 ± 6.1 vs 7.7 ± 4.0 mmHg, p = 0.098) and significantly higher compared with DuraGen™ (5.5 ± 4.6 mmHg, p = 0.02). No significant differences between the two semisynthetic products were found (p = 0.34). The time required for duraplasty 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).Table 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)

Intraoperative handling, CSF tightness, time for duraplasty. a Scores evaluated after surgical procedures (see “Materials and methods”). b CSF tightness was similar between the devices with best CSF tightness of periosteum. c Time required for closure of the dura mater was significantly lower with BCM and DuraGen™ compared with periosteum
© Copyright Policy
Related In: Results  -  Collection

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

Fig2: Intraoperative handling, CSF tightness, time for duraplasty. a Scores evaluated after surgical procedures (see “Materials and methods”). b CSF tightness was similar between the devices with best CSF tightness of periosteum. c Time required for closure of the dura mater was significantly lower with BCM and DuraGen™ compared with periosteum
Mentions: Table 1 and Fig. 2 summarize the results of the questionnaires completed after wound closure to evaluate device handling. Results for both onlay grafts were similar, with a trend for better adhesion to dura and higher CSF tightness for BCM. Workability of the onlay grafts was better compared with periosteum. However, periosteum yielded higher watertightness. This is supported by the CSF tightness measurements, which revealed CSF tightness at higher ICPs for duraplasty with periosteum compared with BCM (12.3 ± 6.1 vs 7.7 ± 4.0 mmHg, p = 0.098) and significantly higher compared with DuraGen™ (5.5 ± 4.6 mmHg, p = 0.02). No significant differences between the two semisynthetic products were found (p = 0.34). The time required for duraplasty 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).Table 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