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Entezami P, Field NC, Qian J, Yamamoto J. Delayed hypersensitivity reaction to a dural repair substitute. Br J Neurosurg 2024; 38:761-764. [PMID: 34397313 DOI: 10.1080/02688697.2021.1967879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Modern neurosurgeons commonly rely on dural grafts to aid in obtaining watertight closures when the native dura itself cannot be approximated. CASE PRESENTATION We present a patient who developed a symptomatic, delayed hypersensitivity reaction to a cellulose-based synthetic dural graft, which resolved after reoperation and removal of the graft. DISCUSSION Dural grafts are a safe and common implant utilized in neurosurgery. Nevertheless, as with all implanted material, there is a chance for symptomatic immune reactions to occur. CONCLUSION This type of response is exceedingly uncommon, but recognition of this rare presentation may help other providers recognize it in the future.
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Affiliation(s)
- Pouya Entezami
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Nicholas C Field
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Jiang Qian
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | - Junichi Yamamoto
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
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2
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Komatsu H, Watanabe S, Ito S, Nagasaka K, Nishiguchi A, Taguchi T. Improved Swelling Property of Tissue Adhesive Hydrogels Based on α-Cyclodextrin/Decyl Group-Modified Alaska Pollock Gelatin Inclusion Complexes. Macromol Biosci 2023; 23:e2300097. [PMID: 37102468 DOI: 10.1002/mabi.202300097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/06/2023] [Indexed: 04/28/2023]
Abstract
Adhesives/sealants are used after suturing to prevent leakage of cerebrospinal fluid from an anastomotic site. Commercial adhesives/sealants have been used to close the cerebral dura. However, swelling of the cured adhesives/sealants induces increased intracranial pressure and decreases the strength of the seal. In the present study, tissue adhesive hydrogels with improved swelling property using inclusion complex composed of α-cyclodextrin (αCD) and decyl group (C10)-modified Alaska pollock-derived gelatin (C10-ApGltn) with a high degree of substitution (DS) (>20 mol%) are developed. Viscosity of C10-ApGltn with a high DS solution remarkably decreased by the addition of αCD. The resulting αCD/C10-ApGltn adhesive hydrogel composed of αCD/C10-ApGltn inclusion complexes and poly(ethylene glycol) (PEG)-based crosslinker showed improved swelling property after immersion in saline. Also, the resulting adhesive has a significantly higher burst strength than fibrin-based adhesives and is as strong as a PEG-based adhesive. Quantitative analysis of αCD revealed that the improved swelling property of the resulting adhesive hydrogels is induced by the release of αCD from cured adhesive, and the subsequent assembly of decyl groups in the saline. These results suggest that adhesives developed using the αCD/C10-ApGltn inclusion complex can be useful for closing the cerebral dura mater.
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Affiliation(s)
- Hiyori Komatsu
- Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
- Biomaterials Field, Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan
| | - Shiharu Watanabe
- Biomaterials Field, Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan
| | - Shima Ito
- Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
- Biomaterials Field, Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan
| | - Kazuhiro Nagasaka
- Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
- Biomaterials Field, Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan
| | - Akihiro Nishiguchi
- Biomaterials Field, Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan
| | - Tetsushi Taguchi
- Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
- Biomaterials Field, Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan
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Kinaci A, van Thoor S, Redegeld S, Tooren M, van Doormaal TPC. Ex vivo evaluation of a multilayered sealant patch for watertight dural closure: cranial and spinal models. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:85. [PMID: 34297226 PMCID: PMC8302489 DOI: 10.1007/s10856-021-06552-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Cerebrospinal fluid leakage is a frequent complication after cranial and spinal surgery. To prevent this complication and seal the dura watertight, we developed Liqoseal, a dural sealant patch comprising a watertight polyesterurethane layer and an adhesive layer consisting of poly(DL-lactide-co-ε-caprolactone) copolymer and multiarmed N-hydroxylsuccinimide functionalized polyethylene glycol. We compared acute burst pressure and resistance to physiological conditions for 72 h of Liqoseal, Adherus, Duraseal, Tachosil, and Tisseel using computer-assisted models and fresh porcine dura. The mean acute burst pressure of Liqoseal in the cranial model (145 ± 39 mmHg) was higher than that of Adherus (87 ± 47 mmHg), Duraseal (51 ± 42 mmHg) and Tachosil (71 ± 16 mmHg). Under physiological conditions, cranial model resistance test results showed that 2 of 3 Liqoseal sealants maintained dural attachment during 72 hours as opposed to 3 of 3 for Adherus and Duraseal and 0 of 3 for Tachosil. The mean burst pressure of Liqoseal in the spinal model (233 ± 81 mmHg) was higher than that of Tachosil (123 ± 63 mmHg) and Tisseel (23 ± 16 mmHg). Under physiological conditions, spinal model resistance test results showed that 2 of 3 Liqoseal sealants maintained dural attachment for 72 hours as opposed to 3 of 3 for Adherus and 0 of 3 for Duraseal and Tachosil. This novel study showed that Liqoseal is capable of achieving a strong watertight seal over a dural defect in ex vivo models.
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Affiliation(s)
- A Kinaci
- Department of Neurology and Neurosurgery, Brain Center Rudolph Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Brain Technology Institute, Utrecht, The Netherlands
| | - S van Thoor
- Brain Technology Institute, Utrecht, The Netherlands
| | - S Redegeld
- Brain Technology Institute, Utrecht, The Netherlands
| | - M Tooren
- Polyganics BV, Groningen, The Netherlands
| | - T P C van Doormaal
- Department of Neurology and Neurosurgery, Brain Center Rudolph Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands.
- Brain Technology Institute, Utrecht, The Netherlands.
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Lee P, Krisht KM, Cai L, Krisht AF. Autologous Temporalis Subfascial Fat Graft for Skull Base Repair: A Novel Technique. Oper Neurosurg (Hagerstown) 2021; 20:E274-E278. [PMID: 33469665 DOI: 10.1093/ons/opaa442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Autologous abdominal fat grafts are occasionally used in the repair of skull base exposures. This surgical procedure typically requires an additional surgical site and may have unexpected postoperative complications. OBJECTIVE To describe an operative technique for harvesting subfascial fat from the temporal extension of the buccal fat pad for the repair of skull base defects. METHODS We review the pertinent anatomy of the temporalis subfascial fat pad and discuss the technique used to harvest the subfascial fat component in a clinical presentation. RESULTS A pretemporal approach was performed for clip ligation of an anterior circulation aneurysm. A standard frontotemporal incision was made with an interfascial flap to preserve the frontalis branches of the facial nerve. The subfascial fat was inspected and determined to be adequate for harvesting. Monopolar cauterization was carefully utilized to remove the fat. During closure, the graft was used to repair a pneumatized clinoid sinus and for the dural repair of the pretemporal exposure. The patient did not have any postoperative complications. CONCLUSION Autologous temporalis subfascial fat graft is a viable and safe technique for skull base dural and sinus repair during frontotemporal approaches in select patients. This technique avoids an additional surgical procedure and potential complications that may be associated with it.
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Affiliation(s)
- Paul Lee
- Department of Neurological Surgery, CHI St. Vincent Arkansas Neuroscience Institute, Sherwood, Arkansas
| | - Khaled M Krisht
- Department of Neurological Surgery, CHI St. Vincent Arkansas Neuroscience Institute, Sherwood, Arkansas
| | - Li Cai
- Department of Neurological Surgery, CHI St. Vincent Arkansas Neuroscience Institute, Sherwood, Arkansas
| | - Ali F Krisht
- Department of Neurological Surgery, CHI St. Vincent Arkansas Neuroscience Institute, Sherwood, Arkansas
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Marton E, Giordan E, Gallinaro P, Curzi C, Trojan D, Paolin A, Guerriero A, Rossi S, Bendini M, Longatti P, Canova G. Homologous amniotic membrane as a dural substitute in decompressive craniectomies. J Clin Neurosci 2021; 89:412-421. [PMID: 34052070 DOI: 10.1016/j.jocn.2021.05.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/19/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A dura mater substitute in decompressive craniectomies must protect the brain while providing a dissection plane between the cortex and myocutaneous layer. The human amniotic membrane (AM) has anti-inflammatory, wound healing, and differentiation properties. We tested AM properties as a dural substitute by comparing the outcomes to biological ones. METHODS We prospectively collected data on 25 patients who randomly underwent decompressive craniectomy with lyophilized AM patches and 25 in which biological substitutes were utilized between 2015 and 2019. The AM was laid with the epithelial side facing the brain because of the anti-adhesive proprieties, while the chorion facing the myocutaneous flap. We collected data on demographics, neurological status, comorbidities, and surgical outcomes. Additionally, we created a score - dura mimicking score- and reviewed postoperative imaging and pathological specimens. RESULTS The majority (96%) of AM grafts were integrated into native dura. Thirteen patients scored as excellent and 11 good on our "dura mimicking score", showing tissue integration ability but no cerebral cortex adhesion. The histopathological analysis showed that AM had thick plates of dense fibrous tissue with small reactive vessels, reactive fibroblasts, and lymphocytes infiltrate. The AM group's first outcomes were not different from the biological substitute patients but higher integration rate to the dura and less adhesion to the myocutaneous flap in AM patients. CONCLUSIONS We documented the anti-adhesive, protective, and integrative properties of AM dural substitute patches in patients who underwent decompressive craniectomies, comparing the intraoperative differences and postoperative outcomes to biological dural substitutes.
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Affiliation(s)
| | - Enrico Giordan
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy.
| | - Paolo Gallinaro
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy
| | - Christian Curzi
- Department of Neuroscience, University of Padova, Padova, Italy
| | | | | | - Angela Guerriero
- Department of Pathology, Aulss 2 Marca Trevigiana, Treviso, Italy
| | - Sabrina Rossi
- Department of Pathology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Matteo Bendini
- Department of Radiology, Aulss 2 Marca Trevigiana, Treviso, Italy
| | | | - Giuseppe Canova
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy
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Callovini GM, Bolognini A, Callovini T, Giordano M, Gazzeri R. Treatment of CSF leakage and infections of dural substitute in decompressive craniectomy using fascia lata implants and related anatomopathological findings. Br J Neurosurg 2020; 35:18-21. [PMID: 32138540 DOI: 10.1080/02688697.2020.1735301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Decompressive craniectomy (DC) is widely used to treat raised intracranial pressure (ICP) in cranial trauma and stroke. It is accompanied by numerous complications. The aim of our study is to assess the surgical treatment of infections related to the use of a dural substitute with concurrent CSF leakage performed at our institution. MATERIAL AND METHODS A retrospective analysis of a series of 72 patients who underwent DC between 2011 and 2017 was performed. Seven cases (9%) showed infection related to the use of xenograft (bovine pericardium) and coexisting CSF leakage. Epidural/subdural empyemas were observed in seven cases; three in conjunction with an intracerebral abscess. For reconstruction, free anterolateral thigh fascia lata flaps were used, based on the size of the defect. RESULTS After removal of the dural substitute and the implant of free fascia lata, infection and CSF leaks resolved in all. An anatomopathological examination of the implant at the later time of cranioplasty (CP) showed the tissue had become vascularized exhibiting integration with the native dura. No complications related to the harvesting of the fascia lata were observed. CONCLUSIONS Fascia lata is a validated source of autologous grafts; it is cost-free and would appear to be the biological material most similar to the dura mater. The implanted material appears to maintain a lasting vitality when covered over with a well-vascularized scalp, even after a period of months, achieving a successful suppression of infection. Subsequent skull reconstruction is performed safely and easily using artificial bone.
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Affiliation(s)
| | - Andrea Bolognini
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Tommaso Callovini
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Marco Giordano
- Department of Pathology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Roberto Gazzeri
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy
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Kizmazoglu C, Ozyoruk S, Husemoglu RB, Kalemci O, Sozer G, Sade B. Comparison of dural closure alternatives: an experimental study. Br J Neurosurg 2019; 33:655-658. [PMID: 31544534 DOI: 10.1080/02688697.2019.1667481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Dural closure preference has been a topic of debate in contemporary neurosurgery. This study aims to compare different closure techniques using an in vitro model.Methods: Human cadaveric dura mater was attached to a cylindrical metal glass filled with blue dyed saline. A 1 cm dural incision was made. Dural closure was performed using three different techniques. Each group had six samples: Group I - interrupted simple 4-0 polyglactin suture (S) only, Group II - S plus on lay collagen graft, Group III - S plus fibrin sealant. In Group NS, a 1 cm × 1 cm dural window was made. An onlay collagen graft was used with no suturing for this group to serve as an overtly weak reconstruction reference. Primary and secondary leak pressures were recorded (PLP and SLP, respectively).Results: All groups (I-III) had significantly higher PLP and SLP than Group NS. PLP was significantly higher in Group III as compared to groups I and II. Groups I and II had similar PLP values. SLP was similar in all three groups.Conclusion: In this study, the use of fibrin sealant has proven to be the best option in preventing dural leak. However, no technique was superior in the case of SLP.
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Affiliation(s)
- Ceren Kizmazoglu
- Department of Neurosurgery, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Safak Ozyoruk
- Department of Neurosurgery, Ardahan State Hospital, Ardahan, Turkey
| | - Resit Bugra Husemoglu
- Department of Biomechanics, Dokuz Eylul University School of Medicine Health Science Institute, Izmir, Turkey
| | - Orhan Kalemci
- Department of Neurosurgery, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gulden Sozer
- Department of Pathology, Forensic Medicine Institution, Izmir, Turkey
| | - Burak Sade
- Department of Neurosurgery, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Lewis KM, Sweet J, Wilson ST, Rousselle S, Gulle H, Baumgartner B. Safety and Efficacy of a Novel, Self-Adhering Dural Substitute in a Canine Supratentorial Durotomy Model. Neurosurgery 2019; 82:397-406. [PMID: 28575349 PMCID: PMC6018778 DOI: 10.1093/neuros/nyx216] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 04/04/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leaks increase postoperative risk for complication, likelihood of reoperation, and costs. OBJECTIVE To investigate a novel, self-adhering polyethylene glycol-coated collagen pad (PCC) as a dural substitute relative to Duragen XS (DGX; Integra LifeSciences Corporation, Plainsboro, New Jersey) and as a dural sealant relative to Tachosil (Takeda Austria GmbH, Linz, Austria), a fibrinogen and thrombin-coated collagen pad (FTC). METHODS A canine supratentorial durotomy surgical model was used to investigate the safety and efficacy of PCC. For safety, 4 animals were bilaterally treated with DGX or PCC and recovered for 1, 8, or 16 wk; total 24 animals. Each animal underwent physical and neurological examinations weekly and 16-wk animals underwent a magnetic resonance imaging (MRI) examination at each time point. For efficacy, 9 animals were unilaterally treated with FTC or PCC and underwent a burst pressure test intraoperatively or 14 d postoperatively; total 36 animals. RESULTS In the safety study, no abnormal clinical signs or changes were noted on physical and neurological examinations, or in clinical pathology, CSF analysis or histopathology of DGX or PCC-treated animals. No consistent signs of cerebral compression, CSF leak, hemorrhage, or hydrocephalus were noted on MRI. In the efficacy study, no significant difference was found between FTC and PCC at each time point or overall (13.9 vs 12.3 mm Hg, n = 18 per group, P = .46). CONCLUSION PCC is safe for use as a dural substitute and effective as a dural sealant. The novel, self-adhering combination of a polyethylene glycol-based sealant and a collagen pad may offer unique benefits to the advancement of duraplasty.
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Affiliation(s)
| | | | | | | | - Heinz Gulle
- Baxter Medical Products GmbH, Vienna, Austria
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9
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Supratentorial Craniotomies with or without Dural Closure—A Comparison. World Neurosurg 2019; 125:e1132-e1137. [DOI: 10.1016/j.wneu.2019.01.262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 11/19/2022]
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10
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Bohoun CA, Goto T, Morisako H, Nagahama A, Tanoue Y, Ohata K. Skull Base Dural Repair Using Autologous Fat as a Dural Substitute: An Efficient Technique. World Neurosurg 2019; 127:e896-e900. [PMID: 30959259 DOI: 10.1016/j.wneu.2019.03.293] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dural repair during skull base approaches remains challenging, especially in the presence of significant defects. The autologous fat has become an alternative to various substitute materials being used previously. We report here our experience and technique for the repair of notable skull base dural defects using autologous fat as a dural substitute. METHODS Over a period of 5 years, 71 consecutive patients operated on for skull base pathologies with an important intraoperative dural defect repaired using autologous fat tissue as replacement material were reviewed. The graft, withdrawn from the abdomen or thigh, was flattened and applied to the defect. The clinical findings and outcomes were assessed. RESULTS Main pathologies included schwannomas (45%) and meningiomas (35.21%), with no side predilection. Surgical approaches such as transcondylar fossa, suboccipital, and frontotemporal approaches were used. Dural defects were mainly located in the posterior (73.2%) and middle cranial fossae (25.4%). No harvesting site-related complication occurred. In 7 cases, transitory subcutaneous fluid collection spontaneously resorbing after 8 days to 2 months was observed. No external cerebrospinal fluid leakage, infection, or other complication was noted during the following period. CONCLUSIONS Dural repair can be effectively and durably achieved using autologous fat graft as a dural substitute during skull base approaches, even in cases of extended defects. The observed characteristics of the fat graft along with the achieved outcome make it an ideal dural substitute.
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Affiliation(s)
- Christian A Bohoun
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Takeo Goto
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Morisako
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Atsufumi Nagahama
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuta Tanoue
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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De Rome K, Warner E, Barkas K, Thomas N, Barazi S, Surda P. Our experience with a novel CSF leak repair material in 14 patients following anterior skull base surgery. Clin Otolaryngol 2019; 44:416-419. [PMID: 30644651 DOI: 10.1111/coa.13287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/08/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Katherine De Rome
- Department of Otolaryngology, Guy's and St Thomas' Hospital, London, UK
| | - Elinor Warner
- Department of Otolaryngology, Guy's and St Thomas' Hospital, London, UK
| | - Kostas Barkas
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Nick Thomas
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Sinan Barazi
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Pavol Surda
- Department of Otolaryngology, Guy's and St Thomas' Hospital, London, UK
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12
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Spinali KL, Schmuck EG. Natural Sources of Extracellular Matrix for Cardiac Repair. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1098:115-130. [PMID: 30238368 DOI: 10.1007/978-3-319-97421-7_6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Tissue engineering and regenerative medicine have adopted the use of extracellular matrix (ECM) as a cell delivery device and bioactive regenerative agent. To this end, many ECMs have been investigated for cardiac tissue engineering and regenerative medicine applications with variable success. Many sources of natural ECMs have been tested for cardiac applications. Typically, natural ECMs have been made from decellularized organs or tissues and processed into either sheets or injectable hydrogels. This chapter will review natural sources of ECM materials that have been tested as therapeutic agents in models of heart failure.
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Affiliation(s)
- Keith L Spinali
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin Madison, Madison, WI, USA
| | - Eric G Schmuck
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin Madison, Madison, WI, USA.
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Pathrose Kamalabai R, Nagar M, Chandran R, Mohammed Haneefa Suharanbeevi S, Bhanu Prabhakar R, Peethambaran A, Mallika Dhanapalan S, Jain S, Sharma S. Rationale Behind the Use of Double-Layer Polypropylene Patch (G-patch) Dural Substitute During Decompressive Craniectomy as an Adhesion Preventive Material for Subsequent Cranioplasty with Special Reference to Flap Elevation Time. World Neurosurg 2017; 111:e105-e112. [PMID: 29233748 DOI: 10.1016/j.wneu.2017.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Dural substitutes are used in decompressive craniectomy (DC) to prevent adhesions during subsequent cranioplasty. Current literature attributes them to reduced blood loss and reduction in operative time of cranioplasty. The use of double-layer substitute has rarely been documented. We studied the use of double-layer G-patch as a dural substitute in DC and evaluated its outcome during subsequent cranioplasty with special focus on flap elevation time and blood loss during cranioplasty. METHODS We performed emergency frontotemporoparietal decompressive craniectomy using a double layer of G-patch as dural substitute. Subsequent cranioplasty was done in these 35 patients. The development of adhesion formation between the tissue layers, amount of blood loss, and flap elevation time were recorded. RESULTS During the cranioplasty, a clear and smooth plane of dissection was found between the 2 layers of G-patch in all cases. Average flap elevation time was 21.8 minutes, and average time taken for cranioplasty was 124.12 minutes. Average blood loss was 83 mL. None of the patients required re-exploration for infection of bone flap or postoperative bleed. CONCLUSIONS While evaluating the use of dural substitute during DC as an adhesion preventive material for subsequent cranioplasty, flap elevation time and blood loss should be taken into account rather than operative time. Double-layer G-patch during DC facilitates subsequent cranioplasty by preventing adhesions between the layers, resulting in easier dissection and reduced blood loss.
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Affiliation(s)
| | - Milesh Nagar
- Department of Neurosurgery, Government Medical College, Trivandrum, Kerala, India.
| | - Raj Chandran
- Department of Neurosurgery, Government Medical College, Trivandrum, Kerala, India
| | | | | | - Anil Peethambaran
- Department of Neurosurgery, Government Medical College, Trivandrum, Kerala, India
| | | | - Sourabh Jain
- Department of Neurosurgery, Government Medical College, Trivandrum, Kerala, India
| | - Saurabh Sharma
- Department of Neurosurgery, Government Medical College, Trivandrum, Kerala, India
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Deng K, Yang Y, Ke Y, Luo C, Liu M, Deng Y, Tian Q, Yuan Y, Yuan T, Xu T. A novel biomimetic composite substitute of PLLA/gelatin nanofiber membrane for dura repairing. Neurol Res 2017; 39:819-829. [DOI: 10.1080/01616412.2017.1348680] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kunxue Deng
- Department of Mechanical Engineering and Biomedical Engineering Program, University of Texas at El Paso, El Paso, TX, USA
- Department of Mechanical Engineering, Bio-manufacturing Center, Tsinghua University, Beijing, China
- Medprin Institute of Technology (MIT), Guangzhou, China
| | - Yaya Yang
- Department of Mechanical Engineering and Biomedical Engineering Program, University of Texas at El Paso, El Paso, TX, USA
- Department of Mechanical Engineering, Bio-manufacturing Center, Tsinghua University, Beijing, China
- Multidisciplinary Research Center, Shantou University, Shantou, China
| | - Yiquan Ke
- Department of Neurosurgery, Zhujiang Hospital of South Medical University, Guangzhou, China
| | - Chengyi Luo
- Department of Neurosurgery, Zhujiang Hospital of South Medical University, Guangzhou, China
| | - Man Liu
- School of Bioscience & Bioengineering, South China University of Technology, Guangzhou, China
| | - Yuting Deng
- School of Bioscience & Bioengineering, South China University of Technology, Guangzhou, China
| | - Quan Tian
- School of Bioscience & Bioengineering, South China University of Technology, Guangzhou, China
| | - Yuyu Yuan
- School of Bioscience & Bioengineering, South China University of Technology, Guangzhou, China
| | - Tun Yuan
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Tao Xu
- Department of Mechanical Engineering and Biomedical Engineering Program, University of Texas at El Paso, El Paso, TX, USA
- Department of Mechanical Engineering, Bio-manufacturing Center, Tsinghua University, Beijing, China
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15
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Shen Y, Ma C, Wang L, Li J, Wu Y, Sun J. Surgical Management of Giant Cell Tumors in Temporomandibular Joint Region Involving Lateral Skull Base: A Multidisciplinary Approach. J Oral Maxillofac Surg 2016; 74:2295-2311. [DOI: 10.1016/j.joms.2016.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/02/2016] [Accepted: 04/06/2016] [Indexed: 12/12/2022]
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16
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Di Vitantonio H, De Paulis D, Del Maestro M, Ricci A, Dechordi SR, Marzi S, Millimaggi DF, Galzio RJ. Dural repair using autologous fat: Our experience and review of the literature. Surg Neurol Int 2016; 7:S463-8. [PMID: 27500007 PMCID: PMC4960926 DOI: 10.4103/2152-7806.185777] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/27/2016] [Indexed: 12/11/2022] Open
Abstract
Background: Various materials have been proposed to obliterate dead spaces and to reconstruct dural defects during a neurosurgical approach. This study describes our technique of using the abdominal autologous fat graft and evaluates the complications and characteristics related to the use of this tissue during cranial procedures. Methods: Autologous fat grafts were used in 296 patients with basicranial and convexity extraaxial tumors from April 2005 to January 2015. The adipose tissue was removed from the paraumbilical abdominal region and was transformed into a thin foil. When possible, a watertight suture was made between the dural or bone edge with a fat graft. We always used fibrin glue to reinforce the dural closure. Results: Complications occurred between 2 days and 1 year following procedure. Cerebrospinal fluid leaks were found in 11 cases. No case of mortality, pseudomeningoceles, fistula, infections, bacterial meningitides, or lipoid meningitides was reported. No patient required removal of the graft. No adhesion was observed between the brain and the autologous fat. Other fat-related complications observed were 2 cases of fat necrosis in the abdomen and 2 cases of abdominal hemorrhage. Conclusion: The technique of harvesting and applying fat grafts is fairly simple, although it must be performed meticulously to be effective. Our experience has led us to believe that the use of fat grafts presents low morbidity and mortality. However, a neurosurgeon should never forget the possible late or early complications related to the use of fat grafts.
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Affiliation(s)
- Hambra Di Vitantonio
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Danilo De Paulis
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | - Mattia Del Maestro
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | - Soheila Raysi Dechordi
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Sara Marzi
- Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy
| | - Daniele F Millimaggi
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Renato J Galzio
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
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17
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Suwanprateeb J, Luangwattanawilai T, Theeranattapong T, Suvannapruk W, Chumnanvej S, Hemstapat W. Bilayer oxidized regenerated cellulose/poly ε-caprolactone knitted fabric-reinforced composite for use as an artificial dural substitute. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2016; 27:122. [PMID: 27278580 DOI: 10.1007/s10856-016-5736-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Abstract
A novel bilayer knitted fabric-reinforced composite for potentially being used as a dural substitute was developed by solution infiltration of oxidized regenerated cellulose knitted fabric (ORC) with poly ε-caprolactone (PCL) solution at various concentrations ranging 10-40 g/100 mL. It was found that the density of all formulations did not differ significantly and was lower than that of the human dura. Microstructure of the samples typically comprised a bilayer structure having a nonporous PCL layer on one side and the ORC/PCL composite layer on another side. Tensile modulus and strength of the samples initially decreased with increasing PCL solution concentration for up to 20 g/100 mL and re-increased again with further increasing PCL solution concentration. Strain at break of all formulations were not significantly different. Watertight test revealed that all composites could prevent leakage at the pressure within the normal range of intracranial pressure. In vitro degradation study revealed that the weight loss percentage and change in tensile properties of all samples displayed biphasic profile comprising an initially rapid decrease and followed by a gradual decrease with incubation times afterward. Micro and macro porous channels were observed to be in situ generated in the composite layer by ORC dissolution and PCL resorption during degradation while nonporous layer remained relatively unchanged. The degradation rate was found to decrease with increasing PCL solution concentration. In vitro biocompatibility using alamar blue assay on selected samples showed that fibroblasts could attach and proliferate well at all incubation periods.
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Affiliation(s)
- Jintamai Suwanprateeb
- National Metal and Materials Technology Center (MTEC), Paholyothin Road, Klong 1, Klongluang, 12120, Pathumthani, Thailand
| | - Ticomporn Luangwattanawilai
- Department of Pharmacology, Faculty of Science, Mahidol University, Rama VI Road, Rajthevee, Bangkok, 10400, Thailand
| | - Thunyanun Theeranattapong
- Department of Pharmacology, Faculty of Science, Mahidol University, Rama VI Road, Rajthevee, Bangkok, 10400, Thailand
| | - Waraporn Suvannapruk
- National Metal and Materials Technology Center (MTEC), Paholyothin Road, Klong 1, Klongluang, 12120, Pathumthani, Thailand
| | - Sorayouth Chumnanvej
- Neurosurgery Unit, Surgery Department, Faculty of Medicine, Ramathibodi Hospital, Rama VI Road, Rajthevee, Bangkok, 10400, Thailand
| | - Warinkarn Hemstapat
- Department of Pharmacology, Faculty of Science, Mahidol University, Rama VI Road, Rajthevee, Bangkok, 10400, Thailand.
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18
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Kjartansson H, Olafsson IH, Karason S, Thorisson H, Baldursson BT, Gunnarsson E, Jorundsson E, Sigurjonsson GF. Use of Acellular Fish Skin for Dura Repair in an Ovine Model: A Pilot Study. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojmn.2015.54021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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