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

Histological analysis at 1 month postoperatively. a Histology of an animal randomized to duraplasty with BCM. Neither the cortical lesion (CL) nor the leptomeninges were markedly adherent to the device (D), which showed isolated lymphocytic infiltration. b Duraplasty with DuraGen™ (i, ii) or periosteum (iii, iv)
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3197932&req=5

Fig4: Histological analysis at 1 month postoperatively. a Histology of an animal randomized to duraplasty with BCM. Neither the cortical lesion (CL) nor the leptomeninges were markedly adherent to the device (D), which showed isolated lymphocytic infiltration. b Duraplasty with DuraGen™ (i, ii) or periosteum (iii, iv)

Mentions: In the BCM group, seven of eight specimens (87.5%) showed no adhesions of the graft to the leptomeninges, whereas the leptomeninges were adherent to the device in one of eight (12.5%). Cortical lesion was adherent to the graft in six of eight specimens (75%), while one of eight (12.5%) showed no adhesion, and scar formation was observed in one of eight (12.5%). Lymphocytic infiltration of the graft was absent in two of eight (25%) and isolated lymphocytic infiltration present in three of eight (37.5%). In two of eight (25%) there was massive lymphocytic infiltration, and a granuloma was observed in one of eight (12.5%), most likely due to intraoperative contamination. Isolated lymphocytic infiltration of the cortex were observed in five of eight specimens (62.5%), but it was massive in two of eight (25%) of specimens. One of eight (12.5%) specimens showed ingrowth of connective tissue into the cortex. Advanced integration of the graft into the dura with little acellular collagen remaining was found in seven of eight (87.5%) specimens, but one of eight (12.5%) showed a complete integration (Table 2, Fig. 4).Table 2


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 analysis at 1 month postoperatively. a Histology of an animal randomized to duraplasty with BCM. Neither the cortical lesion (CL) nor the leptomeninges were markedly adherent to the device (D), which showed isolated lymphocytic infiltration. b Duraplasty with DuraGen™ (i, ii) or periosteum (iii, iv)
© Copyright Policy
Related In: Results  -  Collection

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

Fig4: Histological analysis at 1 month postoperatively. a Histology of an animal randomized to duraplasty with BCM. Neither the cortical lesion (CL) nor the leptomeninges were markedly adherent to the device (D), which showed isolated lymphocytic infiltration. b Duraplasty with DuraGen™ (i, ii) or periosteum (iii, iv)
Mentions: In the BCM group, seven of eight specimens (87.5%) showed no adhesions of the graft to the leptomeninges, whereas the leptomeninges were adherent to the device in one of eight (12.5%). Cortical lesion was adherent to the graft in six of eight specimens (75%), while one of eight (12.5%) showed no adhesion, and scar formation was observed in one of eight (12.5%). Lymphocytic infiltration of the graft was absent in two of eight (25%) and isolated lymphocytic infiltration present in three of eight (37.5%). In two of eight (25%) there was massive lymphocytic infiltration, and a granuloma was observed in one of eight (12.5%), most likely due to intraoperative contamination. Isolated lymphocytic infiltration of the cortex were observed in five of eight specimens (62.5%), but it was massive in two of eight (25%) of specimens. One of eight (12.5%) specimens showed ingrowth of connective tissue into the cortex. Advanced integration of the graft into the dura with little acellular collagen remaining was found in seven of eight (87.5%) specimens, but one of eight (12.5%) showed a complete integration (Table 2, Fig. 4).Table 2

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