Collagen matrix duraplasty for cranial and spinal surgery: a clinical and imaging study.
OBJECTIVE
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.
Narotam
Pradeep K
PK
Division of Neurosurgery, Creighton University, Omaha, Nebraska 68131, USA. narotam@creighton.edu
Reddy
Kesava
K
Fewer
Derek
D
Qiao
Fan
F
Nathoo
Narendra
N
D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000008:administration & dosage* / Q000009:adverse effects; D016022:Case-Control Studies; D003094:Collagen / Q000008:administration & dosage* / Q000009:adverse effects; D004388:Dura Mater / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012886:Skull / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome
D001672:Biocompatible Materials; D003094:Collagen