Abstract
Accurate biomechanical properties of the human dura mater are required for computational models and to fabricate artificial substitutes for transplantation and surgical training purposes. Here, a systematic literature review was performed to summarize the biomechanical properties of the human dura mater that are reported in the literature. Furthermore, anthropometric data, information regarding the mechanically tested samples, and specifications with respect to the used mechanical testing setup were extracted. A meta-analysis was performed to obtain the pooled mean estimate for the elastic modulus, ultimate tensile strength, and strain at maximum force. A total of 17 studies were deemed eligible, which focused on human cranial and spinal dura mater in 13 and 4 cases, respectively. Pooled mean estimates for the elastic modulus (n = 448), the ultimate tensile strength (n = 448), and the strain at maximum force (n = 431) of 68.1 MPa, 7.3 MPa and 14.4% were observed for native cranial dura mater. Gaps in the literature related to the extracted data were identified and future directions for mechanical characterizations of human dura mater were formulated. The main conclusion is that the most commonly used elastic modulus value of 31.5 MPa for the simulation of the human cranial dura mater in computational head models is likely an underestimation and an oversimplification given the morphological diversity of the tissue in different brain regions. Based on the here provided meta-analysis, a stiffer linear elastic modulus of 68 MPa was observed instead. However, further experimental data are essential to confirm its validity.
Highlights
With the abrupt rise of biomechanical research based on computational models (Chafi et al 2009; Kleiven 2003; Viano et al 2005; Zhang et al 2001a) and the fabrication1 3 Vol.:(0123456789)Tutopatch (Tutogen Medical GmbH, Neunkirchen am Brand, Germany) (Kizmazoglu et al 2019)
If unrealistic biomechanical properties are used in computational models, the predictions that are made based on these models such as the development of subdural bleedings related to particular head impact directions (Kleiven 2003) or the responses of the brain–spinal cord complex to particular head impacts (Kimpara et al 2006) are likely invalid
Apart from one quasi-static study that was conducted on 12 cadavers, all values for the elastic modulus of fresh human cranial dura mater were higher than the single dynamic elastic modulus value provided by Galford and McElhaney (1970)
Summary
With the abrupt rise of biomechanical research based on computational models (Chafi et al 2009; Kleiven 2003; Viano et al 2005; Zhang et al 2001a) and the fabrication1 3 Vol.:(0123456789)Tutopatch (Tutogen Medical GmbH, Neunkirchen am Brand, Germany) (Kizmazoglu et al 2019). The biomechanical properties of cranial dura mater are required to accurately simulate the tissue in computational head models to answer predominantly impact-related research questions (Chafi et al 2009; Kizmazoglu et al 2019; Viano et al 2005; Zhang et al 2001a). For the latter, an elastic modulus of 31.5 MPa that was observed in dynamic vibration tests 50 years ago (Galford and McElhaney 1970) is most frequently applied (Chafi et al 2009; Kleiven 2003; Viano et al 2005; Zhang et al 2001a). If unrealistic biomechanical properties are used in computational models, the predictions that are made based on these models such as the development of subdural bleedings related to particular head impact directions (Kleiven 2003) or the responses of the brain–spinal cord complex to particular head impacts (Kimpara et al 2006) are likely invalid
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