Dural reconstruction with usage of xenogenic bio­material

Authors: Z. Večeřa 1;  O. Krejčí 1;  M. Houdek 1;  R. Lipina 1;  M. Kanta 2
Authors‘ workplace: Neurochirurgická klinika LF OU a FN Ostrava 1;  Neurochirurgická klinika LF UK a FN Hradec Králové 2
Published in: Cesk Slov Neurol N 2018; 81(6): 686-690
Category: Original Paper
doi: 10.14735/amcsnn2018686



Watertight dural reconstruction represents the golden standard of every intradural surgery.


Autologous graft versus xenogenic graft comparison in dural reconstruction. Patients and methods: Our prospective study evaluated data of 86 patients who underwent a neurosurgical procedure. We divided patients into two groups. We used an autologous graft (fascia, periost) in the first group and xenogenic bio­material in the second group to perform dural reconstruction. Xenogenic biomaterial was Dural graft Biodesign® (Cook-Medical, Bloomington, IN, USA). In both groups, we assessed the incidence of cerebrospinal fluid leakage, infectious and non-infectious complications of wound healing.


Cerebrospinal fluid leakage occurred in the group with the xenogenic dural graft in 11.6% and in the group with the autologous graft in 9.3%. Infection rate was low, 4.6% in both groups. All patients received standard wound care according to the workplace routine. We detected no alergic reaction or graft rejection in any of our patients. Complete follow up was successful in 77 cases (89.5%) of all pacients. Difference between incidence of liquor fistula showed no statistical difference in both groups (p < 0.05).


Application of xenogenic graft is very easy and simple and we consider it suitable for dural reconstruction.

Klíčová slova:

tvrdá plena – likvorová píštěl – meningitida – neurochirurgie

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Chinese summary - 摘要






患者和方法:我们的前瞻性研究评估了86例接受神经外科手术的患者的数据。 我们将患者分为两组。 我们在第一组使用自体移植物(筋膜,骨膜),在第二组使用异种生物材料进行硬脑膜重建。 异种生物材料是Dural graft Biodesign(Cook-Medical,Bloomington,IN,USA)。 在两组中,我们评估了脑脊液漏,伤口愈合的感染性和非感染性并发症的发生率。


异种硬膜移植组发生脑脊液漏11.6%,自体移植组9.3%。 感染率低; 两组均为4.6%。 所有患者均根据工作场所常规接受标准伤口护理。 我们在任何患者中均未发现过敏反应或移植排斥反应。 所有患者中77例(89.5%)完成随访。 两组间酒瘘发生率差异无统计学差异(p <0.05)。




硬脑膜 - 脑脊液漏 - 脑膜炎 - 神经外科


1. Grotenhuis JA. Costs of postoperative cerebrospinal fluid leakage: 1-year, retrospective analysis of 412 consecutive nontrauma cases. Surg Neurol 2005; 64(6): 490–493. doi: 10.1016/j.surneu.2005.03.041.

2. Cobb MA, Badylak SF, Janas W et al. Histology after dural grafting with small intestinal submucosa. Surg Neurol 1996; 46(4): 389–394.

3. Cobb MA, Badylak SF, Janas W et al. Porcine small intestinal submucosa as a dural substitute. Surg Neurol 1999; 51(1): 99–104.

4. Dejardin LM, Arnoczky SP, Clarke RB. Use of small intestinal submucosal implants for regeneration of large fascial defects: an experimental study in dogs. J Biomed Mater Res 1999; 46(2): 203–211.

5. Welch JA, Montgomery RD, Lenz SD et al. Evaluation of small-intestinal submucosa implants for repair of meniscal defects in dogs. Am J Vet Res 2002; 63(3): 427–431.

6. Bejjani GK, Zabramski J, Durasis Study Group. Safety and efficacy of the porcine small intestinal submucosa dural substitute: results of a prospective multicenter study and literature review. J Neurosurg 2007; 106(6): 1028–1033. doi: 10.3171/jns.2007.106.6.1028.

7. Badylak S, Kokini K, Tullius B et al. Morphologic study of small intestinal submucosa as a body wall repair device. J Surg Res 2002; 103(2): 190–202.

8. Abbe R. Rubber tissue for meningeal adhesions. Trans Am Surg Assoc 1895; 13: 490–491.

9. Filippi R, Schwarz M, Voth D et al. Bovine pericardium for duraplasty: clinical results in 32 patients. Neurosurg Rev 2001; 24: 103–107.

10. Parizek J, Mericka P, Husck Z 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 duroplasty in neurosurgery. Acta Neurochir (Wien) 1997; 139(9): 827–838.

11. Sharkey PC, Usher FC, Robertson RC. Lyophilized human dura mater as a dural substitute. J Neurosurg 1958; 15(2): 192–198. doi: 10.3171/jns.1958.15.2.0192.

12. Preusser M, Ströbel T, Gelpi E et al. Alzheimer-type in a 28 year old patient with iatrogenic Creutzfeldt-Jakob disease after dural grafting. J Neurol Neurosurg Psychiatry 2006; 77(3): 413–416. doi: 10.1136/jnnp.2005.070805.

13. Brooke FJ, Boyd A, Klug GM et al. Lyodura use and the risk of iatrogenic Creutzfeldt-Jakob disease in Australia. Med J Aust 2004; 180(4): 177–181.

14. Warren WL, Medary MB, Dureza CD et al. Dural repair using acellular human dermis : experience with 200 cases : technique assessment. Neurosurgery 2000; 46(6): 1391–1396.

15. Turchan A, Rochman TF, Ibrahim A et al. Duraplasty using amniotic membrane versus temporal muscle fascia: a clinical comparative study. J Clin Neurosci 2018; 50: 272–276. doi: 10.1016/j.jocn.2018.01.069.

16. Azzam D, Prasanth R, Thien N et al. Dural repair in cranial surgery is associated with moderate rates of complications with both autologous and nonautologous dural substitutes. World Neurosurg 2018; 113: 244–248. doi: 10.1016/j.wneu.2018.01.115.

17. Vieira E, Guimarães TC, Faquini IV et al. Randomized controlled study comparing 2 surgical techniques for decompressive craniectomy: with watertight duraplasty and without watertight duraplasty. J Neurosurg 2018; 129(4): 1017–1023. doi: 10.3171/2017.4.JNS152954.

18. Barth M, Tuettenberg J, Thomé C et al. Watertight dural closure: is it necessary? A prospective randomized trial in patients with supratentorial craniotomies. Neurosurgery 2008; 63(4 Suppl 2): 352–358. doi: 10.1227/01.NEU.0000310696.52302.99.

19. Sade B, Oya S, Lee JH. Non-watertight dural reconstruction in meningioma surgery: results in 439 consecutive patients and a review of the literature. Clinical article. J Neurosurg 2011; 114(3): 714–718. doi: 10.3171/2010.7.JNS10460.

20. Kshettry VR, Lobo B, Lim J et al. Evaluation of non-watertight dural reconstruction with collagen matrix onlay graft in posterior fossa surgery. J Korean Neurosurg Soc 2016; 59(1): 52–57. doi: 10.3340/jkns.2016.59.1.52.

21. von Wild KR. Examination of the safety and efficacy of an absorbable dura mater substitute (Dura Patch) in normal applications in neurosurgery. Surg Neurol 1999; 52(4): 418–424.

22. Mailliti M, Page P, Gury C et al. Comparison of deep wound infection rates using a synthethic dural substitute(neuro-patch) or pericranium graft for dural closure: a clini­-cal review of 1 year. Neurosurgery 2004; 54(3): 559–603.

23. Messing-Jünger AM, Ibáñez J, Calbucci F et al. Effectiveness and handling characteristics of a three-layer polymer dura substitute: a prospective multicenter clinical study. J Neurosurg 2006; 105(6): 853–858. doi: 10.3171/jns.2006.105.6.853.

24. Danish SF, Samdani A, Hanna A et al. Experience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations. J Neurosurg 2006; 104 (1 Suppl): 16–20. doi: 10.3171/ped.2006.104.1.16.

25. Narotam PK, Qiao F, Nathoo N. Collagen matrix duraplasty for posterior fossa surgery: evaluation of surgical technique in 52 adult patients. Clinical article. J Neurosurg 2009; 111(2): 380–386. doi: 10.3171/2008.10.JNS08993.

26. Parlato C, di Nuzzo G, Luongo M et al. Use of a collagen bio­matrix (TissuDura) for dura repair: a long-term neuroradiological and neuropathological evaluation. Acta Neurochir 2011; 153(1): 142–147. doi: 10.1007/s00701-010-0718-2.

27. Di Vitantonio H, De Paulis D, Del Maestro M et al. Dural repair using autologous fat: our experience and review of the literature. Surg Neurol Int 2016; 7 (Suppl 16): S463–S468. doi: 10.4103/2152-7806.185777.

28. Hutter G, Felten Sv, Sailer MH et al. Risk factors for postoperative CSF leakage after elective craniotomy and the efficacy of fleece-bound tissue sealing against dural suturing alone: a randomised controlled trial. J Neurosurg 2014; 121(3): 735–744. doi: 10.3171/2014.6.JNS131917.

Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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