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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

Histological and macroscopic analysis at 6 months postoperatively. Skull was carefully separated from the specimens before embedding. During this procedure the adhesion was scored (compare results section)
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Fig3: Histological and macroscopic analysis at 6 months postoperatively. Skull was carefully separated from the specimens before embedding. During this procedure the adhesion was scored (compare results section)

Mentions: Animals from periosteum (n = 4), DuraGen™ (n = 3) and BCM (n = 5) groups were sacrificed at 24 weeks postoperatively. At this time point, reossification had closed the defects in the former osteoclastic craniotomy area in all animals. CSF fistulas, abscesses, infections, seromas or signs of intracranial infection were not evident in any of the animals. In the BCM group, one of five specimens (20%) showed no adhesion, while soft or considerable adhesion of device to the cortex was detected in one of five (20%) and three of five (60%), respectively. In the DuraGen™ group, two of three specimens (66.6%) showed no adhesion, while one of three (33.3%) showed soft adhesion between device and the cortex. In the periosteum group, considerable adherence (75%) and soft adhesion (25%) between the graft and the cortex was observed (Table 3, Fig. 3).Fig. 3


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)

Histological and macroscopic analysis at 6 months postoperatively. Skull was carefully separated from the specimens before embedding. During this procedure the adhesion was scored (compare results section)
© Copyright Policy
Related In: Results  -  Collection

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

Fig3: Histological and macroscopic analysis at 6 months postoperatively. Skull was carefully separated from the specimens before embedding. During this procedure the adhesion was scored (compare results section)
Mentions: Animals from periosteum (n = 4), DuraGen™ (n = 3) and BCM (n = 5) groups were sacrificed at 24 weeks postoperatively. At this time point, reossification had closed the defects in the former osteoclastic craniotomy area in all animals. CSF fistulas, abscesses, infections, seromas or signs of intracranial infection were not evident in any of the animals. In the BCM group, one of five specimens (20%) showed no adhesion, while soft or considerable adhesion of device to the cortex was detected in one of five (20%) and three of five (60%), respectively. In the DuraGen™ group, two of three specimens (66.6%) showed no adhesion, while one of three (33.3%) showed soft adhesion between device and the cortex. In the periosteum group, considerable adherence (75%) and soft adhesion (25%) between the graft and the cortex was observed (Table 3, Fig. 3).Fig. 3

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