Allergic reaction to a bovine dural substitute following spinal cord untethering

Case report

Andrew B. Foy M.D.1, Caterina Giannini M.D.2, and Corey Raffel M.D., Ph.D.1
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  • 1 Departments of Neurologic Surgery and
  • | 2 Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, Minnesota
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✓Bovine tissues are now routinely used for dural closure in cranial and spinal surgery. The authors report the case of an 18-year-old woman with a history of myelomeningocele who had symptoms of tethered cord syndrome and presented to a regional hospital. At that hospital she underwent a cord untethering procedure. The spinal dura was closed with Durepair, a dural substitute derived from fetal bovine skin. Her postoperative course was complicated by a cerebrospinal fluid leak that was surgically repaired. Following this, she developed erythroderma, intermittent fevers, eosinophilia, and marked elevation in serum immunoglobulin E. She was then transferred to the authors' institution. A skin antigen test to beef was administered, which revealed a positive reaction. A radioallergosorbent test to beef also yielded positive results. She was taken to the operating room for removal of the bovine graft due to concern for an allergic reaction to the graft. The graft material showed evidence of eosinophilic infiltration. Her clinical symptoms and laboratory values all improved after surgery. To the authors' knowledge this is the first reported case of an allergic reaction to bovine-based dural substitutes.

Abbreviations used in this paper:

CSF = cerebrospinal fluid; RAST = radioallergosorbent test.

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  • 1

    Alleyne CH Jr, & Barrow DL: Immune response in hosts with cadaveric dura grafts. Report of two cases. J Neurosurg 81:610613, 1994

  • 2

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

  • 3

    Araújo JD, , Braile DM, , Azenha Filho JO, , Barros ET, & Marconi A: Use of bovine pericardium as an arterial graft. A 5-year follow-up. J Cardiovasc Surg (Torino) 28:434439, 1987

    • Search Google Scholar
    • Export Citation
  • 4

    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
  • 5

    Barbolt TA, , Odin M, , Léger M, , Kangas L, , Hoiste J, & Liu SH: Biocompatibility evaluation of dura mater substitutes in an animal model. Neurol Res 23:813820, 2001

    • Search Google Scholar
    • Export Citation
  • 6

    Braile DM, , Ardito RV, , Greco OT, & Lorga AM: IMC bovine pericardial valve: 11 years. J Card Surg 6:4 Suppl 580588, 1991

  • 7

    Cobb MA, , Badylak SF, , Janas W, & Boop FA: Histology after dural grafting with small intestinal submucosa. Surg Neurol 46:389394, 1996

  • 8

    Crawford FA Jr, , Sade RM, & Spinale F: Bovine pericardium for correction of congenital heart defects. Ann Thoracic Surg 41:602605, 1986

  • 9

    Fillipi R, , Schwartz 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
  • 10

    Gök A, , Zorludemir S, , Polat S, , Tap O, & Kaya M: Experimental evaluation of peritoneum and pericardium as dural substitutes. Res Exp Med (Berl) 195:3138, 1995

    • Search Google Scholar
    • Export Citation
  • 11

    Haq I, , Cruz-Almeida Y, , Siqueira EB, , Norenberg M, , Green BA, & Levi AD: Postoperative fibrosis after surgical treatment of the porcine spinal cord: a comparison of dural substitutes. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 2:5054, 2005

    • Search Google Scholar
    • Export Citation
  • 12

    Johnson MH, & Thompson EJ: Freeze-dried cadaveric dural grafts can stimulate a damaging immune response in the host. Eur Neurol 20:445447, 1981

    • Search Google Scholar
    • Export Citation
  • 13

    Kadowaki MH, , Levett JM, , Manjoney DL, , Grina NM, & Glagov S: Comparison of prosthetic graft material as intracardiac right atrial patches. J Surg Res 41:6574, 1986

    • Search Google Scholar
    • Export Citation
  • 14

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

    • Search Google Scholar
    • Export Citation
  • 15

    Parizek J, , Mericka P, , Husek Z, , Suba P, , Spacek J, & Nemecek S, et al.: 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
  • 16

    Park TS, , Delashaw JB, , Broaddus WC, & Vollmer DG: Lyophilized cadaver dura mater for primary repair of myelomeningoceles. Pediatr Neurosci 12:315319, 1986

    • Search Google Scholar
    • Export Citation
  • 17

    Skinner JR, , Kim H, , Toon RS, , Kongtahworn C, , Phillip SJ, & Zeff RH: Inflammatory epicardial reaction to processed bovine pericardium: case report. J Thorac Cardiovasc Surg 88:789791, 1984

    • Search Google Scholar
    • Export Citation
  • 18

    Venes JL: Surgical considerations in the initial repair of meningomyelocele and the introduction of a technical modification. Neurosurgery 17:111114, 1985

    • Search Google Scholar
    • Export Citation
  • 19

    Zerris VA, , James KS, , Roberts JB, , Bell E, & Heilman CB: Repair of the dura mater with processed collagen devices. J Biomed Mater Res B Appl Biomater 83B:580588, 2007

    • Search Google Scholar
    • Export Citation

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