Collagen matrix duraplasty for cranial and spinal surgery: a clinical and imaging study

Pradeep K. Narotam M.D. 1 , 2 , Kesava Reddy M.D., F.R.C.S.C. 3 , Derek Fewer M.D., F.R.C.S.C. 4 , Fan Qiao M.D., PH.D. 1 and Narendra Nathoo M.D., PH.D. 1
View More View Less
  • 1 Division of Neurosurgery, Creighton University, Omaha, Nebraska
  • 2 Health Sciences Center, General Hospital, Winnipeg, Manitoba
  • 3 Hamilton Health Sciences Corporation, Hamilton, Ontario and
  • 4 Winnipeg Children’s Hospital, Winnipeg, Manitoba, Canada
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

The repair of dural defects is controversial in contemporary neurosurgery. To date, collagen-based products remain a continued area of interest in the development of dural grafts. The authors conducted a prospective case–control study in which they evaluated collagen matrix in the repair of dural defects following cranial and spinal surgery by using specific clinical and magnetic resonance (MR) imaging outcome measures.

Methods

Enrolled in the study were 79 patients, 36 male (45.6%) and 43 female (54.4%), with a mean age of 53 ± 15.8 years. The pathological diagnosis was brain tumor in 49 cases (62%), vascular conditions in 16 (20.2%), degenerative spine in 10 (12.7%), trauma in two (2.5%), and other in two (2.5%). Most of the patients underwent supratentorial craniotomy (57; 72.2%), whereas 11 patients (13.9%) each underwent posterior fossa and spinal surgery. Sixty-three patients (79.7%) completed the study, which included clinical and MR imaging evaluations at 3 months postsurgery. There were no cerebrospinal fluid (CSF) leaks or delayed hemorrhages. The neurosurgical wound infection rate was 3.8%: superficial wound infection in two cases and deep infection and brain abscess in one case (recurrent brain tumor following radiation therapy).

Among the 63 patients in whom 3-month postsurgery imaging data were available, asymptomatic small pseudomeningoceles were detected on MR imaging in two (3.2%); a minor subgaleal fluid collection, which resolved spontaneously, was apparent in another patient (1.6%). Nonspecific dural enhancement was demonstrated on images obtained in seven patients (11.1%), and asymptomatic spinal epidural enhancement was observed on images obtained in two of three patients who had undergone lumbar laminectomy for spinal stenosis.

Conclusions

When used as a dural onlay graft, collagen matrix had a 100% CSF containment rate but might be associated with occult radiological abnormalities.

Abbreviations used in this paper:CSF = cerebrospinal fluid; CT = computed tomography; MR = magnetic resonance.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Pradeep K. Narotam, M.D., Division of Neurosurgery, Creighton University, 601 North 30th Street, #3700, Omaha, Nebraska 68131. email: narotam@creighton.edu.
  • 1

    Adegbite AB, , Paine KW, & Rozdilsky B: The role of neomembranes in formation of hematoma around Silastic dura substitute. Case report. J Neurosurg 58:295297, 1983

    • Search Google Scholar
    • Export Citation
  • 2

    Anson JA, & Marchand EP: Bovine pericardium for dural grafts: clinical results in 35 patients. Neurosurgery 39:764768, 1996

  • 3

    Baharuddin A, , Go BT, , Firdaus MN, & Abdullah J: Bovine pericardium for dural graft: clinical results in 22 patients. Clin Neurol Neurosurg 104:342344, 2002

    • Search Google Scholar
    • Export Citation
  • 4

    Banerjee T, , Meagher JN, & Hunt WE: Unusual complications with use of silastic dural substitute. Am Surg 40:434437, 1974

  • 5

    Bartosz DK, & Vasterling MK: Dura mater substitutes in the surgical treatment of meningiomas. J Neurosci Nurs 26:140145, 1994

  • 6

    BenDebba M, , Augustus van Alphen H, & Long DM: Association between peridural scar and activity-related pain after lumbar discectomy. Neurol Res 21:1 Suppl S37S42, 1999

    • Search Google Scholar
    • Export Citation
  • 7

    Blomstedt GC: Infections in neurosurgery: a retrospective study of 1143 patients and 1517 operations. Acta Neurochir (Wien) 78:8190, 1985

    • Search Google Scholar
    • Export Citation
  • 8

    Burke JW, , Podrasky AE, & Bradley WG Jr: Meninges: benign postoperative enhancement on MR images. Radiology 174:99102, 1990

  • 9

    Clark RP, , Robertson JH, , Shea JJ, & Tomoda K: Closure of dural defects with proplast. Am J Otol 5:179182, 1984

  • 10

    Cohen AR, , Aleksic S, & Ransohoff J: Inflammatory reaction to synthetic dural substitute. Case report. J Neurosurg 70:633635, 1989

  • 11

    Cook SD, , Prewett AB, , Dalton GE, & Whitecloud TS III: Reduction in perineural scar formation after laminectomy with Polyactive membrane sheets. Spine 19:18151825, 1994

    • Search Google Scholar
    • Export Citation
  • 12

    Coplin WM, , Cullen NK, , Policherla PN, , Vinas FC, , Wilseck JM, & Zafonte RD, : Safety and feasibility of craniectomy with dura-plasty as the initial surgical intervention for severe traumatic brain injury. J Trauma 50:10501059, 2001

    • Search Google Scholar
    • Export Citation
  • 13

    Coskun E, , Suzer T, , Topuz O, , Zencir M, , Pakdemirli E, & Tahta K: Relationships between epidural fibrosis, pain, disability, and psychological factors after lumbar disc surgery. Eur Spine J 9:218223, 2000

    • Search Google Scholar
    • Export Citation
  • 14

    Costantino PD: Human dural replacement with acellular dermis: clinical results and a review of the literature. Head Neck 23:343, 2001

  • 15

    Costantino PD, , Wolpoe ME, , Govindaraj S, , Chaplin JM, , Sen C, & Cohen M, : Human dural replacement with acellular dermis: clinical results and a review of the literature. Head Neck 22:765771, 2000

    • Search Google Scholar
    • Export Citation
  • 16

    de Tribolet N, , Porchet F, , Lutz TW, , Gratzl O, , Brotchi J, & van Alphen HA, : Clinical assessment of a novel antiadhesion barrier gel: prospective, randomized, multicenter, clinical trial of ADCON-L to inhibit postoperative peridural fibrosis and related symptoms after lumbar discectomy. Am J Orthop 27:111120, 1998

    • Search Google Scholar
    • Export Citation
  • 17

    Depreitere B, , Van Calenbergh F, , van Loon J, , Goffin J, & Plets C: Posterior fossa decompression in syringomyelia associated with a Chiari malformation: a retrospective analysis of 22 patients. Clin Neurol Neurosurg 102:9196, 2000

    • Search Google Scholar
    • Export Citation
  • 18

    Djindjian M: [Prevention of wound infections in neurosurgery.]. Neurochirurgie 39:369373, 1993. (Fr)

  • 19

    Ekseth K, & Bostrom S: Late complications of Silastic duraplasty: low-virulence infections. Case report. J Neurosurg 90:559562, 1999

  • 20

    Ellingsworth LR, , DeLustro F, , Brennan JE, , Sawamura S, & McPherson J: The human immune response to reconstituted bovine collagen. J Immunol 136:877882, 1986

    • Search Google Scholar
    • Export Citation
  • 21

    Ernestus RI, , Ketter G, & Klug N: [Dura-plasty in intracranial operations.]. Zentralbl Neurochir 56:106110, 1995. (Ger)

  • 22

    Filippi R, , Schwarz M, , Voth D, , Reisch R, , Grunert P, & Perneczky A: Bovine pericardium for duraplasty: clinical results in 32 patients. Neurosurg Rev 24:103107, 2001

    • Search Google Scholar
    • Export Citation
  • 23

    Fisher WS III, & Braun D: Closure of posterior fossa dural defects using a dural substitute: technical note. Neurosurgery 31:155156, 1992

    • Search Google Scholar
    • Export Citation
  • 24

    Fisher WS III, & Six EG: Cervical myelopathy from dural substitute. Neurosurgery 13:715717, 1983

  • 25

    Gomez H, & Little JR: Spinal cord compression: a complication of silicone-coated Dacron dural grafts. Report of two cases. Neurosurgery 24:115118, 1989

    • Search Google Scholar
    • Export Citation
  • 26

    Herman M, , Pozzi-Mucelli RS, & Skrap M: CT and MRI findings after stereotactic resection of brain lesions. Eur J Radiol 23:228234, 1996

  • 27

    Hochman MS, & Naidich TP: Diffuse meningeal enhancement in patients with overdraining, long-standing ventricular shunts. Neurology 52:406409, 1999

    • Search Google Scholar
    • Export Citation
  • 28

    Jensen TT, , Asmussen K, , Berg-Hansen EM, , Lauritsen B, , Manniche C, & Vinterberg H, : First-time operation for lumbar disc herniation with or without free fat transplantation. Prospective triple-blind randomized study with reference to clinical factors and enhanced computed tomographic scan 1 year after operation. Spine 21:10721076, 1996

    • Search Google Scholar
    • Export Citation
  • 29

    Jinnin M: [An experimental study on the prevention of postlam-inectomy scar formation: efficacy of interpositional collagen-sponge.]. Nippon Seikeigeka Gakkai Zasshi 69:198208, 1995. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 30

    Kanat A: Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. Neurosurgery 43:189190, 1998

    • Search Google Scholar
    • Export Citation
  • 31

    Kuzma B, & Goodman JM: Diffuse dural enhancement. Surg Neurol 46:303, 1996

  • 32

    Laun A, , Tonn JC, & Jerusalem C: Comparative study of lyophilized human dura mater and lyophilized bovine pericardium as dural substitutes in neurosurgery. Acta Neurochir (Wien) 107:1621, 1990

    • Search Google Scholar
    • Export Citation
  • 33

    Lee JF, , Odom GL, & Tindall GT: Experimental evaluation of silicone-coated Dacron and collagen fabric-film laminate as dural substitutes. J Neurosurg 27:558564, 1967

    • Search Google Scholar
    • Export Citation
  • 34

    Macfarlane MR, & Symon L: Lyophilised dura mater: experimental implantation and extended clinical neurosurgical use. J Neurol Neurosurg Psychiatry 42:854858, 1979

    • Search Google Scholar
    • Export Citation
  • 35

    Misra BK, & Shaw JF: Extracerebral hematoma in association with dural substitute. Neurosurgery 21:399400, 1987

  • 36

    Narotam PK, , Jose S, , Nathoo N, , Taylon C, & Vora Y: Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine 29:28612869, 2004

    • Search Google Scholar
    • Export Citation
  • 37

    Narotam PK, , van Dellen JR, , Bhoola K, & Raidoo D: Experimental evaluation of collagen sponge as a dural graft. Br J Neurosurg 7:635641, 1993

    • Search Google Scholar
    • Export Citation
  • 38

    Narotam PK, , van Dellen JR, & Bhoola KD: A clinicopathological study of collagen sponge as a dural graft in neurosurgery. J Neurosurg 82:406412, 1995

    • Search Google Scholar
    • Export Citation
  • 39

    Narotam PK, , van Dellen JR, , du Trevou MD, & Gouws E: Operative sepsis in neurosurgery: a method of classifying surgical cases. Neurosurgery 34:409416, 1994

    • Search Google Scholar
    • Export Citation
  • 40

    Parizek J, , Mericka P, , Husek Z, , Suba P, , Spacek J, & Nemecek S, : Detailed evaluation of 2959 allogeneic and xenogeneic dense connective tissue grafts (fascia lata, pericardium, and dura mater) used in the course of 20 years for duraplasty in neurosurgery. Acta Neurochir (Wien) 139:827838, 1997

    • Search Google Scholar
    • Export Citation
  • 41

    Parizek J, , Mericka P, , Nemecek S, , Nemeckova J, , Spacek J, & Suba P, : Posterior cranial fossa surgery in 454 children. Comparison of results obtained in pre-CT and CT era and after various types of management of dura mater. Childs Nerv Syst 14:426439, 1998

    • Search Google Scholar
    • Export Citation
  • 42

    Parizek J, , Mericka P, , Spacek J, , Nemecek S, , Elias P, & Sercl M, : Xenogeneic pericardium as a dural substitute in reconstruction of suboccipital dura mater in children. J Neurosurg 70:905909, 1989

    • Search Google Scholar
    • Export Citation
  • 43

    Patir R, , Mahapatra AK, & Banerji AK: Risk factors in postoperative neurosurgical infection. A prospective study. Acta Neurochir (Wien) 119:8084, 1992

    • Search Google Scholar
    • Export Citation
  • 44

    Reddy M, , Schoggl A, , Reddy B, , Saringer W, , Weigel G, & Matula C: A clinical study of a fibrinogen-based collagen fleece for dural repair in neurosurgery. Acta Neurochir (Wien) 144:265269, 2002

    • Search Google Scholar
    • Export Citation
  • 45

    River Y, , Schwartz A, , Gomori JM, , Soffer D, & Siegal T: Clinical significance of diffuse dural enhancement detected by magnetic resonance imaging. J Neurosurg 85:777783, 1996

    • Search Google Scholar
    • Export Citation
  • 46

    Ross JS, , Obuchowski N, & Zepp R: The postoperative lumbar spine: evaluation of epidural scar over a 1-year period. AJNR Am J Neuroradiol 19:183186, 1998

    • Search Google Scholar
    • Export Citation
  • 47

    Sahuquillo J, , Rubio E, , Poca MA, , Rovira A, , Rodriguez-Baeza A, & Cervera C: Posterior fossa reconstruction: a surgical technique for the treatment of Chiari I malformation and Chiari I/syringomyelia complex––preliminary results and magnetic resonance imaging quantitative assessment of hindbrain migration. Neurosurgery 35:874885, 1994

    • Search Google Scholar
    • Export Citation
  • 48

    Simpson D, & Robson A: Recurrent subarachnoid bleeding in association with dural substitute. Report of three cases. J Neurosurg 60:408409, 1984

    • Search Google Scholar
    • Export Citation
  • 49

    Tobin GR, , Chvapil M, & Gildenburg PL: Collagen biosynthesis in healing wounds of the spinal cord and surrounding membranes. Surgery 88:231238, 1980

    • Search Google Scholar
    • Export Citation
  • 50

    Vanaclocha V, & Saiz-Sapena N: Duraplasty with freeze-dried cadaveric dura versus occipital pericranium for Chiari type I malformation: comparative study. Acta Neurochir (Wien) 139:112119, 1997

    • Search Google Scholar
    • Export Citation
  • 51

    Vogelsang JP, , Finkenstaedt M, , Vogelsang M, & Markakis E: Recurrent pain after lumbar discectomy: the diagnostic value of peridural scar on MRI. Eur Spine J 8:475479, 1999

    • Search Google Scholar
    • Export Citation
  • 52

    Von Wild KR: Examination of the safety and efficacy of an absorbable dura mater substitute (Dura Patch) in normal applications in neurosurgery. Surg Neurol 52:418425, 1999

    • Search Google Scholar
    • Export Citation

Metrics