DURAL AUGMENTATION : PART I — EVALUATION OF COLLAGEN MATRIX ALLOGRAFTS FOR DURAL DEFECT AFTER CRANIOTOMY

Copyright © 2009 by the Congress of Neurological Surgeons Failure to repair native dura after neurological surgery remains a significant source of morbidity for many neurosurgical procedures. Closure of the dura serves as a mechanical and biological barrier to both the egress of cerebrospinal fluid (CSF) and the ingress of infectious organisms. In many cases, primary closure remains difficult, if not impossible, because of the inherent pathology or the insufficiency of native dura. Since the first report of duraplasty using natural latex in the late 19th century, surgeons and engineers have pursued alternatives for dural substitution, including autograft, allograft, xenograft, and synthetics (1–8, 10, 14, 16–19, 21–25, 27–30, 32–34, 37). Despite decades of research, the incidence of CSF leak (fistula or pseudomeningocele) after craniotomy remains as high as 10% (10, 13). In this report, we present our outcomes and experiences with matrix grafts manufactured from reconstituted type I bovine collagen. This includes use of these grafts in combination with cranioplasty material and dural sealants. In a subsequent report, we will present our institutional experience with the effects of dural sealants on postoperative dural integrity and infection. A single-center retrospective analysis of 475 consecutive neurosurgical procedures in which ABBREVIATIONS: BL, bilayer; CSF, cerebrospinal fluid; ML, monolayer; OR, odds ratio; PEG, polyethylene glycol DURAL AUGMENTATION: PART I—EVALUATION OF COLLAGEN MATRIX ALLOGRAFTS FOR DURAL DEFECT AFTER CRANIOTOMY