Dural defects are common in spinal and cranial neurosurgery.A series of complications,such as cerebrospinal fluid leakage,occur after rupture of the dura.Therefore,treatment strategies are necessary to reduce or avoid...Dural defects are common in spinal and cranial neurosurgery.A series of complications,such as cerebrospinal fluid leakage,occur after rupture of the dura.Therefore,treatment strategies are necessary to reduce or avoid complications.This review comprehensively summarizes the common causes,risk factors,clinical complications,and repair methods of dural defects.The latest research progress on dural repair methods and materials is summarized,including direct sutures,grafts,biomaterials,non-biomaterial materials,and composites formed by different materials.The characteristics and efficacy of these dural substitutes are reviewed,and these materials and methods are systematically evaluated.Finally,the best methods for dural repair and the challenges and future prospects of new dural repair materials are discussed.展开更多
Spinal extradural meningeal cysts(SEMCs)are rare lesions of the spinal canal.Although closure of the dural defect can achieve satisfactory therapeutic effects,locating the fistula is difficult.This review summarizes t...Spinal extradural meningeal cysts(SEMCs)are rare lesions of the spinal canal.Although closure of the dural defect can achieve satisfactory therapeutic effects,locating the fistula is difficult.This review summarizes the methods for locating the fistula of SEMCs and the distribution and features of fistula sites.This was a non-systematic literature review of studies on SEMCs.We searched PubMed for English-language articles to summarize the methods of locating the defect.The search words were“epidural arachnoid cyst,”“dural cyst,”“epidural cyst,”and“epidural meningeal cyst.”For the defect location component of the study,case reports,studies with a sample size less than four,controversial ventral dural dissection(s),and undocumented fistula location reports were excluded.Our review showed that radiography and computed tomography(CT)may show changes in the bony structure of the spine,with the largest segment of change indicating the fistula site.Occasionally,magnetic resonance imaging(MRI)can show a cerebrospinal fluid(CSF)flow void at the fistula site.The middle segment of the cyst on sagittal MRI,the largest cyst area,and cyst laterality in the axial view indicate the fistula location.Myelography can show the fistula location in the area of the enhanced cyst and subarachnoid stenosis.Digital subtraction or delayed CT can be used to observe the location of the initial cyst filling.Cine MRI and time-spatial labeling inversion pulse techniques can be used to observe CSF flow.Steady-state image construction interference sequence MRI has a high spatial resolution.Neuroendoscopy,MRI myelography,and ultrasound fistula detection can be performed intraoperatively.Moreover,the fistula was located most often in the T12–L1 segment.Identifying the fistula location is difficult and requires a combination of multiple examinations and experience for comprehensive judgment.展开更多
Dural defects are a common problem in clinical practice,and various types of dural substitutes have been used to deal with dural defects.These play an important role in dural repair.Dural substitutes have gradually re...Dural defects are a common problem in clinical practice,and various types of dural substitutes have been used to deal with dural defects.These play an important role in dural repair.Dural substitutes have gradually reached researchers,neurosurgeons,and patients for approval.This article summarizes the structural characteristics of the dura mater and its regeneration after injury,and reviews the state of progress in research and application.It will provide a reference for the development and application of dural substitutes.展开更多
Recently the use of biologic materials as dura mater repair patches has been increasing. The purpose of this study is to assess the basis for efficacy and safety of using a novel fish derived acellular dermis (Kerecis...Recently the use of biologic materials as dura mater repair patches has been increasing. The purpose of this study is to assess the basis for efficacy and safety of using a novel fish derived acellular dermis (Kerecis Omega3 DuraTM). In an ovine model a craniotomy under general anaesthesia was performed. A defect was produced in the dural covering of approximately 1 × 2 cm and closed with an onlay technique, with Kerecis Omega3 Dura. The bone defect was covered with the bony flap and the overlying tissues closed in layers. At 2, 5, 8 and 11 weeks the sheep underwent MRI scanning followed by euthanasia, necropsy and histological assessment. MRI images taken at 2, 5, 8 and 11 weeks showed initially moderate inflammatory response, which diminished over time, and at 11 weeks no evidence of inflammation existed. There was evidence of cerebrospinal fluid leakage at no time point. Necropsy revealed some adhesions at 5 and 8 weeks, in particular at 5 weeks, but at 11 weeks there were no adhesions found. From 2 - 11 weeks, there was evidence of initially an inflammatory reaction followed by neodura formation at the defect site through cellular ingrowth and remodeling of the acellular fish skin. Histology showed a histiocytic foreign body reaction initially that subsided over time. As early as 8 weeks there was evidence of neodura formation and by 11 weeks there was a minimal inflammatory response with an intact neodura formed. In this pilot study the Kerecis Omega3 Dura patches performed in a safe and efficacious manner. This new material needs to be fully assessed and compared with other products that are currently on the market in a larger scale animal study.展开更多
CSFL caused by spinal dural defect is a common complication of spinal surgery,which need repair such as suture or sealants.However,low intracranial pressure symptoms,wound infection and prolonged hospital associated w...CSFL caused by spinal dural defect is a common complication of spinal surgery,which need repair such as suture or sealants.However,low intracranial pressure symptoms,wound infection and prolonged hospital associated with pin-hole leakage or loose seal effect were often occurred after surgical suture or sealants repair.Stable,pressure resistance and high viscosity spinal dural repair patch in wet environment without suture or sealants was highly needed.Herein,a bioactive patch composed of alginate and polyacrylamide hydrogel matrix cross-linked by calcium ions,and chitosan adhesive was proposed.This fabricated patch exhibits the capabilities of promoting defect closure and good tight seal ability with the bursting pressure is more than 790 mm H2O in wet environment.In addition,the chitosan adhesive layer of the patch could inhibit the growth of bacterial in vitro,which is meaningful for the postoperative infection.Furthermore,the patch also significantly reduced the expression of GFAP,IBA-1,MBP,TNF-α,and COX-2 in early postoperative period in vivo study,exerting the effects of anti-inflammatory,analgesic and adhesion prevention.Thus,the bioactive patch expected to be applied in spinal dural repair with the good properties of withstanding high pressure,promoting defect closure and inhibiting postoperative infection.展开更多
基金Supported by Jilin Health Science and Technology Capability Improvement Project,No.2022C107.
文摘Dural defects are common in spinal and cranial neurosurgery.A series of complications,such as cerebrospinal fluid leakage,occur after rupture of the dura.Therefore,treatment strategies are necessary to reduce or avoid complications.This review comprehensively summarizes the common causes,risk factors,clinical complications,and repair methods of dural defects.The latest research progress on dural repair methods and materials is summarized,including direct sutures,grafts,biomaterials,non-biomaterial materials,and composites formed by different materials.The characteristics and efficacy of these dural substitutes are reviewed,and these materials and methods are systematically evaluated.Finally,the best methods for dural repair and the challenges and future prospects of new dural repair materials are discussed.
基金Beijing Natural Science Foundation Grant(L212039)Beijing Hospitals Authority Clinical Medicine Development of special funding support(XMLX202138)the Nonprofit Central Research Institute Fund of Chinese Academy of Medical Sciences(2021-JKCS-015)
文摘Spinal extradural meningeal cysts(SEMCs)are rare lesions of the spinal canal.Although closure of the dural defect can achieve satisfactory therapeutic effects,locating the fistula is difficult.This review summarizes the methods for locating the fistula of SEMCs and the distribution and features of fistula sites.This was a non-systematic literature review of studies on SEMCs.We searched PubMed for English-language articles to summarize the methods of locating the defect.The search words were“epidural arachnoid cyst,”“dural cyst,”“epidural cyst,”and“epidural meningeal cyst.”For the defect location component of the study,case reports,studies with a sample size less than four,controversial ventral dural dissection(s),and undocumented fistula location reports were excluded.Our review showed that radiography and computed tomography(CT)may show changes in the bony structure of the spine,with the largest segment of change indicating the fistula site.Occasionally,magnetic resonance imaging(MRI)can show a cerebrospinal fluid(CSF)flow void at the fistula site.The middle segment of the cyst on sagittal MRI,the largest cyst area,and cyst laterality in the axial view indicate the fistula location.Myelography can show the fistula location in the area of the enhanced cyst and subarachnoid stenosis.Digital subtraction or delayed CT can be used to observe the location of the initial cyst filling.Cine MRI and time-spatial labeling inversion pulse techniques can be used to observe CSF flow.Steady-state image construction interference sequence MRI has a high spatial resolution.Neuroendoscopy,MRI myelography,and ultrasound fistula detection can be performed intraoperatively.Moreover,the fistula was located most often in the T12–L1 segment.Identifying the fistula location is difficult and requires a combination of multiple examinations and experience for comprehensive judgment.
文摘Dural defects are a common problem in clinical practice,and various types of dural substitutes have been used to deal with dural defects.These play an important role in dural repair.Dural substitutes have gradually reached researchers,neurosurgeons,and patients for approval.This article summarizes the structural characteristics of the dura mater and its regeneration after injury,and reviews the state of progress in research and application.It will provide a reference for the development and application of dural substitutes.
文摘Recently the use of biologic materials as dura mater repair patches has been increasing. The purpose of this study is to assess the basis for efficacy and safety of using a novel fish derived acellular dermis (Kerecis Omega3 DuraTM). In an ovine model a craniotomy under general anaesthesia was performed. A defect was produced in the dural covering of approximately 1 × 2 cm and closed with an onlay technique, with Kerecis Omega3 Dura. The bone defect was covered with the bony flap and the overlying tissues closed in layers. At 2, 5, 8 and 11 weeks the sheep underwent MRI scanning followed by euthanasia, necropsy and histological assessment. MRI images taken at 2, 5, 8 and 11 weeks showed initially moderate inflammatory response, which diminished over time, and at 11 weeks no evidence of inflammation existed. There was evidence of cerebrospinal fluid leakage at no time point. Necropsy revealed some adhesions at 5 and 8 weeks, in particular at 5 weeks, but at 11 weeks there were no adhesions found. From 2 - 11 weeks, there was evidence of initially an inflammatory reaction followed by neodura formation at the defect site through cellular ingrowth and remodeling of the acellular fish skin. Histology showed a histiocytic foreign body reaction initially that subsided over time. As early as 8 weeks there was evidence of neodura formation and by 11 weeks there was a minimal inflammatory response with an intact neodura formed. In this pilot study the Kerecis Omega3 Dura patches performed in a safe and efficacious manner. This new material needs to be fully assessed and compared with other products that are currently on the market in a larger scale animal study.
基金supported by Tsinghua University-Peking Union Medical College Hospital Initiative Scientific Research Program(20191080871)the National Natural Science Foundation of China(82002314).
文摘CSFL caused by spinal dural defect is a common complication of spinal surgery,which need repair such as suture or sealants.However,low intracranial pressure symptoms,wound infection and prolonged hospital associated with pin-hole leakage or loose seal effect were often occurred after surgical suture or sealants repair.Stable,pressure resistance and high viscosity spinal dural repair patch in wet environment without suture or sealants was highly needed.Herein,a bioactive patch composed of alginate and polyacrylamide hydrogel matrix cross-linked by calcium ions,and chitosan adhesive was proposed.This fabricated patch exhibits the capabilities of promoting defect closure and good tight seal ability with the bursting pressure is more than 790 mm H2O in wet environment.In addition,the chitosan adhesive layer of the patch could inhibit the growth of bacterial in vitro,which is meaningful for the postoperative infection.Furthermore,the patch also significantly reduced the expression of GFAP,IBA-1,MBP,TNF-α,and COX-2 in early postoperative period in vivo study,exerting the effects of anti-inflammatory,analgesic and adhesion prevention.Thus,the bioactive patch expected to be applied in spinal dural repair with the good properties of withstanding high pressure,promoting defect closure and inhibiting postoperative infection.
