scholarly journals A Comparative Study between Autologous Dural Closure versus Collagen Matrix (DuraGen) Closure in Decompressive Craniectomy for Trauma

2020 ◽  
Vol 17 (01) ◽  
pp. 46-49
Author(s):  
Rajesh Kumar Barooah ◽  
Basanta Kumar Baishya ◽  
Hriday Haloi ◽  
Mrinal Bhuyan ◽  
Asman Ali ◽  
...  
Keyword(s):  
Wound Infection ◽  
Decompressive Craniectomy ◽  
Operating Time ◽  
Collagen Matrix ◽  
Dural Defect ◽  
Temporalis Fascia ◽  
Dural Closure ◽  
Fascia Graft ◽  
Dural Graft ◽  
Csf Leakage

Abstract Introduction Neurosurgeons often deal with the problem of a complete and watertight dural closure after cerebral operative procedures. In decompressive craniectomy done for trauma, autologous grafts such as galea, temporalis fascia can be time consuming. Hence this study was undertaken to look into the outcome using collagen matrix graft for dural closure. Aims and Objectives To study the difference between autologous dural graft closure and collagen matrix graft with respect to the time taken for closure, cerebrospinal fluid (CSF) leakage, and wound infection. Methods This prospective study includes 30 patients who underwent decompressive craniectomy for trauma. Duraplasty with temporalis fascia graft and nonautologous collagen matrix dural patch was done by randomization. Specific time points during craniectomy and cranioplasty was calculated. Total time for the procedures and the time for dural repair and separation was calculated. Results The use of collagen matrix in decompressive craniectomy resulted in decrease in mean operative time during the first surgery by average 45 minutes (p< 0.5) as compared to the use of autologous graft. There is reduction in the operating time during second surgery (cranioplasty) by 35 minutes (p< 0.5). The patients using collagen matrix graft did not record any CSF leakage or wound infection. Excellent uptake of the collagen by the duramater was seen. Conclusion The use of collagen to cover the dural defect for decompressive craniectomy for trauma results in significant reduction in the operating time during the first surgery and also in cranioplasty. There is reduction in CSF leakage and hence duration of hospital stay and cost.

Collagen matrix duraplasty for posterior fossa surgery: evaluation of surgical technique in 52 adult patients

2009 ◽  
Vol 111 (2) ◽  
pp. 380-386 ◽  
Author(s):  
Pradeep K. Narotam ◽  
Fan Qiao ◽  
Narendra Nathoo
Keyword(s):  
Posterior Fossa ◽  
Collagen Matrix ◽  
Adult Patients ◽  
Effective Control ◽  
Posterior Fossa Surgery ◽  
Dural Defect ◽  
Wound Drainage ◽  
Closed Suction ◽  
Dural Closure ◽  
Dural Graft

Object Complete dural closure is not always possible following posterior fossa surgery, often requiring a graft to secure complete closure. The authors report their experience of using a collagen matrix as an onlay dural graft for repair of a posterior fossa dural defect. Methods A retrospective analysis was performed in 52 adult patients who had undergone collagen matrix duraplasty for the posterior fossa. Complications directly related to the dural graft, the presence or absence of hydrocephalus, and the role of closed suction wound drainage in relation to postsurgical pseudomeningoceles were analyzed. Results The indication for posterior fossa surgery was tumors in 32 patients, vascular abnormalities in 9 patients, and spontaneous cerebellar hemorrhage in 11 patients. Closed suction wound drainage was used in 23 patients (44.2%). Forty-eight (92.3%) of 52 patients had a dural defect > 2 cm. Nine (81.8%) of 11 patients with hydrocephalus required ventriculoperitoneal shunts. Complications of the surgery included pseudomeningoceles in 2 patients (3.8%; no closed suction wound drainage); superficial wound infections in 1 patient (1.9%; with closed suction wound drainage); and unexplained eosinophilia in 1 patient. Conclusions Duraplasty using a collagen matrix is safe and effective in the posterior fossa, and is easy to use and time efficient. Meticulous layered wound closure, the detection and effective control of hydrocephalus, and the use of closed suction wound drainage reduces complications related to collagen matrix duraplasty for the posterior fossa.

Efficacy and safety of a collagen matrix for cranial and spinal dural reconstruction using different fixation techniques

2008 ◽  
Vol 109 (2) ◽  
pp. 215-221 ◽  
Author(s):  
Ruediger Stendel ◽  
Marco Danne ◽  
Ingo Fiss ◽  
Ilse Klein ◽  
Andreas Schilling ◽  
...  
Keyword(s):  
Collagen Matrix ◽  
Deep Infection ◽  
Surgical Revision ◽  
Neurosurgical Procedures ◽  
Efficacy And Safety ◽  
Local Skin ◽  
Dural Graft ◽  
Csf Leakage ◽  
Fixation Techniques ◽  
Single Fixation

Object The use of dural grafts is frequently unavoidable when tension-free dural closure cannot be achieved following neurosurgical procedures or trauma. Biodegradable collagen matrices serve as a scaffold for the regrowth of natural tissue and require no suturing. The aim of this study was to investigate the efficacy and safety of dural repair with a collagen matrix using different fixation techniques. Methods A total of 221 patients (98 male and 123 female; mean age 55.6 ± 17.8 years) undergoing cranial (86.4%) or spinal (13.6%) procedures with the use of a collagen matrix dural graft were included in this retrospective study. The indications for use, fixation techniques, and associated complications were recorded. Results There were no complications of the dural graft in spinal use. Five (2.6%) of 191 patients undergoing cranial procedures developed infections, 3 of which (1.6%) were deep infections requiring surgical revision. There was no statistically significant relationship between the operative field status before surgery and the occurrence of a postoperative wound infection (p = 0.684). In the 191 patients undergoing a cranial procedure, cerebrospinal fluid (CSF) collection occurred in 5 patients (2.6%) and a CSF fistula in 5 (2.6%), 3 of whom (1.6%) required surgical revision. No patient who underwent an operation with preexisting CSF leakage had postoperative CSF leakage. Postoperative infection significantly increased the risk for postoperative CSF leakage. The collagen matrix was used without additional fixation in 124 patients (56.1%), with single fixation in 55 (24.9%), and with multiple fixations in 42 (19%). There were no systemic allergic reactions or local skin changes. Follow-up imaging in 112 patients (50.7%) revealed no evidence of any adverse reaction to the collagen graft. Conclusions The collagen matrix is an effective and safe cranial and spinal dural substitute that can be used even in cases of an existing local infection. Postoperative deep infection increases the risk for CSF leakage.

scholarly journals Spinal endoscopy combined with selective CT myelography for dural closure of the spinal dural defect with superficial siderosis: technical note

2018 ◽  
Vol 28 (1) ◽  
pp. 96-102 ◽  
Author(s):  
Hidetaka Arishima ◽  
Yoshifumi Higashino ◽  
Shinsuke Yamada ◽  
Ayumi Akazawa ◽  
Hiroshi Arai ◽  
...  
Keyword(s):  
Endoscopic Examination ◽  
Technical Note ◽  
Drainage Tube ◽  
Superficial Siderosis ◽  
Dural Defect ◽  
Ct Myelography ◽  
Dural Closure ◽  
Spinal Subarachnoid Space ◽  
Csf Leakage ◽  
Dural Defects

The authors describe a new procedure to detect the tiny dural hole in patients with superficial siderosis (SS) and CSF leakage using a coronary angioscope system for spinal endoscopy and selective CT myelography using a spinal drainage tube. Under fluoroscopy, surgeons inserted the coronary angioscope into the spinal subarachnoid space, similar to the procedure of spinal drainage, and slowly advanced it to the cervical spine. The angioscope clearly showed the small dural hole and injured arachnoid membrane. One week later, the spinal drainage tube was inserted, and the tip of the drainage tube was located just below the level of the dural defect found by the spinal endoscopic examination. This selective CT myelography clarifies the location of the dural defect. During surgery, the small dural hole could be easily located, and it was securely sutured. It is sometimes difficult to detect the actual location of the small dural hole even with thin-slice MRI or dynamic CT myelography in patients with SS. The use of a coronary angioscope for the spinal endoscopy combined with selective CT myelography may provide an effective examination to assess dural closure of the spinal dural defect with SS in cases without obvious dural defects on conventional imaging.

scholarly journals Augmentation of dural closure following cerebro-spinal surgeries using Evicel- an experience of 105 patients in India

2021 ◽  
Vol 8 (4) ◽  
pp. 1211
Author(s):  
Batuk D. Diyora ◽  
Nilesh More ◽  
Gagan Dhali
Keyword(s):  
Fibrin Sealant ◽  
Tissue Adhesive ◽  
Dural Defect ◽  
Dural Closure ◽  
Csf Leakage ◽  
Fluid Collections ◽  
Incidental Durotomy ◽  
Dural Suture ◽  
Neurological Surgery ◽  
Csf Leaks

Background: For the neurosurgeon, CSF leaks are a frustrating post-operative complication, and for the patient, it can result in unanticipated morbidity and mortality. Immediate intra-operative recognition of incidental durotomy and dural closure may avoid it. Fibrin sealant is a two-component topical hemostat, dura sealant, and tissue adhesive consisting of fibrinogen and thrombin. We conducted this study to evaluate the efficacy of fibrin sealant Evicel in the management of postoperative CSF leaks as an adjunct to dural suture in patients undergoing a variety of neurosurgical procedures.Methods: This was a retrospective, single-center clinical study conducted on 105 patients who underwent elective neurological surgery from August 2015 to May 2016 at Sion Hospital, India. The efficacy endpoint was the prevention of clinically evident and verified postoperative CSF leak.Results: In all patients, the dural defect was effectively repaired intraoperatively, indicated by the absence of CSF leakage. The success rate of using Evicel was 100% in our cohort for the durasealant efficacy. No adverse effects were reported.Conclusions: We conclude that the use of fibrin sealant Evicel was successful to manage CSF leaks and achieve predictable watertight dural closure resulting in a reduction of intraoperative and postoperative fluid collections. It possesses an acceptable safety profile, consistent with previous findings from other similar studies and studies evaluating the role of Evicel in other surgical indications.

Collagen Matrix in Decompressive Hemicraniectomy

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS176-ONS181 ◽  
Author(s):  
Jorn A. Horaczek ◽  
Jan Zierski ◽  
Alexander Graewe
Keyword(s):  
Cerebrospinal Fluid ◽  
Time Course ◽  
Treatment Time ◽  
Randomized Study ◽  
Operating Time ◽  
Collagen Matrix ◽  
Control Group ◽  
Dural Defect ◽  
Decompressive Hemicraniectomy ◽  
Total Treatment Time

Abstract Objective: Decompressive hemicraniectomy is an accepted treatment for otherwise untreatable intracranial hypertension. The aim of this prospective randomized study is to evaluate the benefit of application of collagen matrix as an onlay graft to reduce operating time during hemicraniectomy and to facilitate dural dissection during secondstage cranioplasty. Methods: Thirty-four consecutive patients were randomized to receive collagen matrix during hemicraniectomy or to undergo the conventional procedure. Specific time points were recorded during hemicraniectomy and cranioplasty. Intra- and postoperative complications, time course of Glasgow Coma Scale, Barthel's, and Early Rehabilitation Indices were monitored. The surgeon had to rate the convenience of the procedure if collagen matrix was used. Cost implications are discussed. Results: The use of collagen matrix during hemicraniectomy resulted in a reduction of combined operating time for hemicraniectomy and cranioplasty by an average of 19.7%. The rate of cerebrospinal fluid effusion during cranioplasty was 13% when collagen was used and 58% in the control group. None of the patients who received collagen developed cerebrospinal fluid effusion persisting longer than 1 week, compared with 33% of patients in the control group. A total of 85% of the surgeons rated the use of collagen matrix as being easier than usual; the rest did not see a difference. Conclusion: The use of collagen matrix to cover the dural defect during hemicraniectomy reduces operating time in hemicraniectomy and cranioplasty. The complication rate (cerebrospinal fluid effusion), total treatment time, and time on intensive care unit can be reduced, giving a potential for cost reduction. There was no difference in the rehabilitative outcome.

Local Tolerance and Biodegradability of a Novel Artificial Dura Mater Graft Following Implantation Onto a Dural Defect in Rabbits

2020 ◽  
Vol 48 (6) ◽  
pp. 738-746
Author(s):  
Yuval Ramot ◽  
Sagi Harnof ◽  
Ido Klein ◽  
Netanel Amouyal ◽  
Michal Steiner ◽  
...  
Keyword(s):  
Dura Mater ◽  
Healing Process ◽  
Collagen Matrix ◽  
Dural Defect ◽  
Local Tolerability ◽  
Local Tolerance ◽  
Bovine Collagen ◽  
Tissue Healing ◽  
Dural Graft ◽  
Synthetic Grafts

Dura mater defects are a common problem following neurosurgery. Dural grafts are used to repair these defects; among them are biodegradable polymeric synthetic grafts. ArtiFascia is a novel synthetic and fibrous Dural graft, composed of poly(l-lactic-co-caprolactone acid) (PLCL) and poly(d-lactic-co-caprolactone acid). In this study, the biodegradability and local tolerance of ArtiFascia was evaluated in rabbits and compared with a bovine collagen matrix as a reference control. ArtiFascia implantation resulted in the formation of neo-dura at the site of implantation and recovery of the dural damage and the calvaria bone above. The implanted graft was completely absorbed after 12 months and the remaining macrophages were morphologically consistent with the anti-inflammatory M2-like phenotype, which contributes to tissue healing and are not pro-inflammatory. The site of the drilled skull bone had a continuous smooth surface, without exuberant tissue or inflammation and a newly formed trabecular bone formation indicated the healing process of the bone. These results support the local tolerability and biodegradability of ArtiFascia when used as a dural graft in rabbits. This study suggests that PLCL-based grafts including ArtiFascia are safe and effective to repair Rabbit Dura.

scholarly journals Pedicled Temporalis Fascia Graft to Repair the Dural Defect in a Case of Compound Depressed Fracture

2017 ◽  
Vol 14 (02/03) ◽  
pp. 101-103
Author(s):  
Amit Agrawal ◽  
Ranjan Jena ◽  
Yashawanth Sandeep ◽  
Ninad Shrikhande
Keyword(s):  
Dural Defect ◽  
Temporalis Fascia ◽  
Depressed Fracture ◽  
Fascia Graft

Non-watertight dural reconstruction in meningioma surgery: results in 439 consecutive patients and a review of the literature

2011 ◽  
Vol 114 (3) ◽  
pp. 714-718 ◽  
Author(s):  
Burak Sade ◽  
Soichi Oya ◽  
Joung H. Lee
Keyword(s):  
Tumor Location ◽  
Infectious Complications ◽  
Csf Leak ◽  
Intracranial Meningioma ◽  
Dural Closure ◽  
Dural Graft ◽  
Csf Leakage ◽  
The Individual ◽  
Meningioma Surgery ◽  
Chemical Meningitis

Object There are various schools of thought when it comes to dural reconstruction following meningioma surgery, which are largely based on the personal experience of the individual surgeons. The authors' aim in this study was to review different dural reconstruction techniques, with an emphasis on their experience with the synthetic onlay dural graft technique. Methods The medical records of 439 consecutive patients who were surgically treated for an intracranial meningioma over a period of 7 years, and for whom dural reconstruction was performed using the onlay dural graft DuraGen (Integra Neurosciences) were reviewed retrospectively. The most common tumor location was the convexity (27.6%), and 12% of the patients had undergone previous surgery. Complications related to the closure technique and/or closure material, such as CSF leakage from the incision, rhinorrhea, or infectious or chemical meningitis were reviewed. Results A CSF leak was encountered in 2 patients (0.4%), and 10 patients (2.3%) experienced graft-related complications in the form of chemical meningitis, cerebritis, and accumulation of extraaxial fluid. Infectious complications were seen in 4 patients (0.9%; bacterial meningitis, osteomyelitis, epidural abscess). None of the patients had pseudomeningocele that required a second intervention. Conclusions In the authors' experience, the incidence of CSF leakage following non-watertight reconstruction of the dura mater in meningioma surgery performed using dural onlay graft was 0.4%. Graft-related complications occurred in 2.3%. These figures compare favorably to the majority of the series in which watertight dural closure is described and emphasized.

scholarly journals Modified Shoelace Dural Closure With Collagen Matrix in Extended Transsphenoidal Surgery

2021 ◽  
Author(s):  
Yuichi Nagata ◽  
Kazuhito Takeuchi ◽  
Hiroo Sasaki ◽  
Akihiro Mizuno ◽  
Hideyuki Harada ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Collagen Matrix ◽  
Closure Technique ◽  
Dural Closure ◽  
Reconstruction Methods ◽  
Csf Leakage ◽  
Effective Option ◽  
Tuberculum Sellae ◽  
Surgical Field ◽  
Sellar Reconstruction

Abstract Extended endonasal transsphenoidal surgery (eTSS) offers a wide surgical field for various parasellar lesions; however, intraoperative high-flow cerebrospinal fluid (CSF) leakage is inevitable. Therefore, secure sellar reconstruction methods are essential to prevent postoperative CSF leakage. Although collagen matrix has been applied for dural reconstruction in neurosurgery, its suitability for application in extended eTSS remains unclear.Fifteen patients underwent modified shoelace dural closure using collagen matrix after lesionectomy via extended eTSS. In this technique, a collagen matrix, which was placed subdurally (inlay graft), was continuously sutured with both open dural edges like a shoelace. Then, another collagen matrix was placed epidurally (onlay graft), and rigid reconstruction was performed using the septal bone and a resorbable fixation mesh. Postoperative CSF leakage did not occur in fourteen patients, but did in one patient with tuberculum sellae meningioma. In this case, the CSF leakage point was detected just around the area between the coagulated dura and the adjacent collagen matrix. The collagen matrix harvested from this area was pathologically examined; neovascularization and fibroblastic infiltration into the collagen matrix were not detected. On the other hand, neovascularization and fibroblast infiltration into the collagen matrix were apparent on the surface of the collagen matrix harvested from the non-CSF leakage area.Our novel dural closure technique using collagen matrix could be an effective option for sellar reconstruction in extended eTSS; however, it should be applied in patients in whom normal dural edges are preserved.Clinical trial registrationNot applicable

scholarly journals A novel duraplasty technique following fenestration of a massive lumbar arachnoid cyst in a patient with scoliosis: technical case report

2018 ◽  
Vol 28 (2) ◽  
pp. 181-185 ◽  
Author(s):  
Matthew T. Neal ◽  
Randall J. Hlubek ◽  
Alexander E. Ropper ◽  
U. Kumar Kakarla
Keyword(s):  
Arachnoid Cyst ◽  
Cauda Equina ◽  
Collagen Matrix ◽  
Dural Defect ◽  
Major Life ◽  
Sensory Deficits ◽  
Dural Closure ◽  
Life Threatening ◽  
Dural Defects

When a dural defect is encountered during spine surgery, the dura mater must be reconstituted to minimize the occurrence of minor or major life-threatening sequelae. The neurosurgical literature lacks strategies for managing large dural defects encountered during surgery. The authors describe a 24-year-old man who developed cauda equina syndrome secondary to altered CSF flow in a large thoracolumbar arachnoid cyst. Surgical decompression and fenestration of the arachnoid cyst were performed, and the large dural defect was treated using a multilayer closure with collagen matrix, titanium mesh, and methylmethacrylate. At his 24-month postoperative follow-up, the patient had recovered full strength in his legs, and his sensory deficits and sexual dysfunction had resolved. His incision had healed well, and there were no signs of pseudomeningocele. He had no additional positional headaches. The defect was managed effectively with this technique. Although this technique is not a first-line strategy for dural closure in the spine, it can be considered in challenging cases when large dural defects are not amenable to traditional closure techniques.

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