title: Use of a collagen biomatrix (TissuDura) for dura repair: a long-term neuroradiological and neuropathological evaluation.
abstract: OBJECTIVE
  The aim of this study was to evaluate the clinical, neuroradiological, and neuropathological outcomes of patients treated with equine collagen foil (TissuDura) as a dura mater substitute during cranial and spinal neurosurgical procedures.
  
  
  METHODS
  All patients treated at the Department of Neurosurgery of the Second University of Naples with TissuDura between 2005 and 2009 were included. Dural reconstruction was performed using TissuDura, overlaid 1 cm over the dural defect with additional fixation using fibrin glue. No surgical sutures were used. Patients underwent postoperative contrast-enhanced magnetic resonance scans at 1 week, 1 month, and 1 year after surgery to detect any cerebrospinal fluid (CSF) leaks, infections, inflammations, or CSF circulation in the surgical region.
  
  
  RESULTS
  Dural reconstruction was performed in 74 patients, including 50 patients with tumors, two with C2 neurinoma, two with acoustic neurinoma, six with Chiari I malformation, two with severe head injury, and 12 requiring spinal surgery. Clinical and neuroradiological findings were normal and no signs of graft rejection or CSF leaks at postoperative follow-up were observed. In two cases of atypical meningioma, re-operation of the dural reconstruction was performed after 1 year. No adherences between brain and neodura were detected, and histopathological investigations demonstrated dural regeneration.
  
  
  CONCLUSIONS
  Following dural reconstructions with TissuDura without surgical sutures, no local toxicity or complications were observed for up to 1 year. TissuDura demonstrated elasticity, non-reactivity, and good adaptability. The overlay technique using fibrin glue was simple and fast. Future studies and longer follow-up are needed to confirm the efficacy of TissuDura.
authors.affiliation: Department of Neurosurgery, Second University of Naples, Naples, Italy. ciro.parlato@unina2.it
authors.forename: Ciro
authors.initials: C
authors.lastname: Parlato
authors.forename: Giuseppe
authors.initials: G
authors.lastname: di Nuzzo
authors.forename: Marianna
authors.initials: M
authors.lastname: Luongo
authors.forename: Raffaele Stefano
authors.initials: RS
authors.lastname: Parlato
authors.forename: Marina
authors.initials: M
authors.lastname: Accardo
authors.forename: Luigi
authors.initials: L
authors.lastname: Cuccurullo
authors.forename: Aldo
authors.initials: A
authors.lastname: Moraci
mesh_terms: D001672:Biocompatible Materials / Q000627:therapeutic use*; D003094:Collagen / Q000737:chemistry / Q000627:therapeutic use; D004388:Dura Mater / Q000737:chemistry / Q000166:cytology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008567:Membranes, Artificial; D019635:Neurosurgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013995:Time
chemical_list: D001672:Biocompatible Materials; D008567:Membranes, Artificial; D003094:Collagen