Abstract
BackgroundDecompressive craniectomy is widely used for treating patients with traumatic brain injury (TBI). Usually patients have dura mater defect due to surgery or injury itself. The defective area may left open or repaired by artificial dura substitutes. A variety of artificial dura substitutes have been used for this purpose.ObjectiveThis study aimed to evaluate bovine‐derived pericardium membrane as artificial dural material for patients with decompressive craniectomy.MethodsTotally 387 patients with severe TBI in our hospital were included in this study. Among them, 192 patients were treated with standard decompressive craniectomy without dura repair (control group). One hundred and ninety‐five TBI patients were treated with dura repair by artificial dura materials (ADM). Nonlyophilized bovine pericardium membranes were used as artificial dura material. The postoperative complications were compared in both groups, including infection, seizure, and cerebrospinal fluid (CSF) leakage.ResultsPatients in control group have higher complication rates than patients in ADM group, including subcutaneous hematoma (13.02% in control vs. 4.01% in ADM group, p = .004), infection (12.5% in control vs. 5.64% in ADM group, p = .021), CSF leakage (13.02% in control vs. 5.13% in ADM group, p = .012), and seizure (10.42% in control vs. 3.08% in ADM group, p = .007). Patients in ADM group are only associated with higher incidence of foreign body reaction (6 of 195 patients in ADM vs. none from control group).ConclusionBovine‐derived pericardium membranes are successfully used as artificial dural substitutes for decompressive craniectomy. Patients with ADM have better clinical outcome than control group.
Highlights
Decompressive craniectomy is widely used for treating patients with traumatic brain injury (TBI)
387 patients with severe TBI were included in this study, 192 patients were treated with standard decompressive craniectomy without dura repair (Control group), and 195 patients were treated with decompressive craniectomy followed artificial dura material repair (ADM group)
The results showed that patients in control group have more complications than patients in artificial dura materials (ADM) group (Table 2); 13.02% patients in control group vs. 4.1% in ADM group had subcutaneous hematoma (OR = 3.349, 95% CI 1.460–7.678, p = .004 after adjustment), 12.5% patients in control group vs. 5.64% in ADM group had intracranial infection (OR = 2.432, 95% CI 1.144–5.170, p = .021 after adjustment), 13.02% patients in control group vs. 5.13% in ADM group had cerebrospinal fluid (CSF) leakage (OR = 2.689, 95% CI, 1.239–5.835, p = .012 after adjustment), and 10.42% in control group vs. 3.08% in ADM group developed seizure (OR = 3.705, 95% CI, 1.436–9.560, p = .007)
Summary
Traumatic brain injury (TBI) is a complex injury with a broad spectrum of symptoms and disabilities, and it is the leading cause of death for individuals in our society between the ages of 1 and 45 (Rutland-Brown, Langlois, Thomas, & Xi, 2006). Some newly developed biomaterials show promising effect in animal models, such as poly (glycolide-c o-lactide)/ type I collagen/chitosan artificial (Bai, Wang, Yuan, Wang, & Wang, 2013), and cellulose knitted fabric (Suwanprateeb et al, 2016) Complications, such as capsule formation, hemorrhage, and extra- axial hematoma formation, were reported caused by these materials (Huang et al, 2011; Matsumoto et al, 2013; Ongkiko et al, 1984). Equine-derived pericardium membrane was used a novel material for dura repair and showed significant therapeutic effect (Centonze, Agostini, Massaccesi, Toninelli, & Morabito, 2016) In this pilot study, none of the eight patients exhibited CSF leak, cerebral contusion, hemorrhage, or wound infection, as well as pseudomeningocele in a follow-up examine (Centonze et al, 2016), indicating xenograft membrane is a good source for artificial dura substitute. The dura patches were tested negative with prion protein as well as other pathogens, and it has met the criteria of China Food and Drug Administration regulation
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