Histopathological Investigation of the Effectiveness of Collagen Matrix in the Repair of Experimental Spinal Dura Mater Defects.

Cagatay Calikoglu,Murteza Cakir,Yusuf Tuzun

doi:10.5152/eurasianjmed.2018.17422

Abstract

This study investigated the suitability of the collagen matrix as a dural graft in the repair of experimental spinal dura mater defects. In the study, 30 New Zealand white rabbits were used. The rabbits were divided into a study and control group. In both groups, following exact laminectomy (Th 10 and 11) in rabbits under the isoflorane anesthesia, a spinal dural defect 1×0.5 cm in size was formed. In the study group, the dura mater defect was covered with collagen matrix; in the control group, the excised dura was sutured back to its original position. At the end of the follow-up period, the rabbits were sacrificed. In all subjects, the vertebral colon was excised completely, and it was fixed in 10% formaldehyde solution. Sections 3 pm thick were taken from the specimens, stained with hematoxylin and eosin, and examined under a light microscope. The stained sections were evaluated under light microscopy with regard to the cellular inflammatory response, fibroblastic proliferation, foreign body reaction, and capsule formation. The collagen matrix was completely absorbed, and it was easy to use since it did not require sutures. Foreign body reactions were minimal in the early period and were resolved entirely in the end. Inflammatory response against the collagen matrix was no greater than in the control group in which the dura was sutured primarily and then closed, eventually disappearing entirely, and no adhesion formation resulted. Collagen permits successful regeneration by combining with the dura mater. No capsule formation was observed in either group. This study shows that collagen is suitable for duraplastic procedures and that it may be a useful agent in patients in whom the dura cannot be closed primarily due to retraction, constriction, or excision.

Highlights

The repair of both cranial and spinal dural defects is still a problem frequently encountered by neurosurgeons
This study investigated the suitability of the collagen matrix as a dural graft in the repair of experimental spinal dura mater defects
This study shows that collagen is suitable for duraplastic procedures and that it may be a useful agent in patients in whom the dura cannot be closed primarily due to retraction, constriction, or excision

Summary

Introduction

The repair of both cranial and spinal dural defects is still a problem frequently encountered by neurosurgeons. Spinal dural defects may arise in association with traumatic or neoplastic destruction, following routine spinal surgery procedures, after neurosurgical interventions requiring dural resection or for congenital reasons such as meningomyelocele, when duraplasty has to be performed [1,2,3] If these defects are not repaired effectively, they may lead to meningoneural adhesions, greater scar tissue formation in the epidural region, pachymeningitis or soft tissue infections, cerebrospinal fluid (CSF) leaks or collections, decreased wound healing, neural herniations, tethered cord and pseudomeningocele development, and to neurological deficits as a consequence [4]. Factors such as the repair of dural defects using familiar suture methods that exacerbate the risk of CSF leaks, neural fiber damage, infection and meningoneural adhesion, or the defect being located in an area where suturing is not possible, have given rise to alternative dural graft materials and experimental evaluation [2, 3, 5]

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