title: Efficacy and safety of a collagen matrix for cranial and spinal dural reconstruction using different fixation techniques.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. ruediger.stendel@charite.de
authors.forename: Ruediger
authors.initials: R
authors.lastname: Stendel
authors.forename: Marco
authors.initials: M
authors.lastname: Danne
authors.forename: Ingo
authors.initials: I
authors.lastname: Fiss
authors.forename: Ilse
authors.initials: I
authors.lastname: Klein
authors.forename: Andreas
authors.initials: A
authors.lastname: Schilling
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hammersen
authors.forename: Terttu
authors.initials: T
authors.lastname: Pietilae
authors.forename: Werner
authors.initials: W
authors.lastname: Jänisch
authors.forename: Werner
authors.initials: W
authors.lastname: Hopfenmüller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D002648:Child; D002675:Child, Preschool; D003094:Collagen; D003399:Craniotomy; D004388:Dura Mater / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology; D007223:Infant; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013131:Spine; D013353:Subdural Effusion / Q000209:etiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control
chemical_list: D001672:Biocompatible Materials; D003094:Collagen