Collagen-only biomatrix as a novel dural substitute

Esposito, Felice; Cappabianca, Paolo; Fusco, M; Cavallo, Luigi Maria; Bani, G. G.; Biroli, Francesco; Sparano, Amelia; Divitiis, Oreste de; Signorelli, Antonio

doi:10.1016/j.clineuro.2007.12.016

Cited by 53 publications

(19 citation statements)

References 37 publications

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“…The full-text of the remaining 78 papers were reviewed and, of these, 40 met the a priori defined selection criteria with 33 meeting that for efficacy and some of these reporting on safety. Two of the 33 papers reported on patients enrolled in a single trial [ 10 , 11 ]. Seven papers contained specific safety reporting on fibrin sealant use in the predefined indication of neurosurgery for dura sealing.…”

Section: Resultsmentioning

confidence: 99%

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Fibrin Sealants in Dura Sealing: A Systematic Literature Review

Esposito

Angileri

Kruse³

et al. 2016

PLoS ONE

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BackgroundFibrin sealants are widely used in neurosurgery to seal the suture line, provide watertight closure, and prevent cerebrospinal fluid leaks. The aim of this systematic review is to summarize the current efficacy and safety literature of fibrin sealants in dura sealing and the prevention/treatment of cerebrospinal fluid leaks.MethodsA comprehensive electronic literature search was run in the following databases: Cochrane Database of Systematic Reviews, Cochrane Central Resister of Controlled Trials, clinicaltrials.gov, MEDLINE/PubMed, and EMBASE. Titles and abstracts of potential articles of interest were reviewed independently by 3 of the authors.ResultsA total of 1006 database records and additional records were identified. After screening for duplicates and relevance, a total of 78 articles were assessed by the investigators for eligibility. Thirty-eight were excluded and the full-text of 40 articles were included in the qualitative synthesis. Seven of these included only safety data and were included in the safety assessment. The remaining 33 articles included findings from 32 studies that enrolled a total of 2935 patients who were exposed to fibrin sealant. Among these 33 studies there were only 3 randomized controlled trials, with the remaining being prospective cohort analysis, case controlled studies, prospective or retrospective case series. One randomized controlled trial, with 89 patients exposed to fibrin sealant, found a greater rate of intraoperative watertight dura closure in the fibrin sealant group than the control group (92.1% versus 38.0%, p<0.001); however, post-operative cerebrospinal fluid leakage occurred in more fibrin sealant than control patients (6.7% versus 2.0%, p>0.05). Other clinical trials evaluated the effect of fibrin sealant in the postoperative prevention of cerebrospinal fluid leaks. These were generally lower level evidence studies (ie, not prospective, randomized, controlled trials) that were not designed or powered to demonstrate a significant advantage to fibrin sealant use. Two small case series studies evaluated the effect of fibrin sealants in persistent cerebrospinal fluid leak treatment, but did not establish firm efficacy conclusions. Specific adverse reports where fibrin sealants were used for dura sealing were limited, with only 8 cases reported in neurosurgical procedures since 1987 and most reporting only a speculative relationship/association with fibrin sealant exposure.ConclusionsA major finding of this systematic literature review is that there is a paucity of randomized studies that have evaluated the effectiveness and safety of fibrin sealants in providing intraoperative watertight dura closure and post-operative cerebrospinal fluid leakage. Among the limited studies available, evidence from a single randomized, controlled trial indicates that fibrin sealants provide a higher rate of intraoperative watertight closure of the dura suture line than control, albeit with a higher rate of postoperative cerebrospinal fluid leakage. Evidence from non-random...

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Section: Resultsmentioning

confidence: 99%

“… Note: multiple publications addressing data from the same study are counted once: *The total of included studies for efficacy and safety is 32, two studies are reporting on the same patients [ 10 , 11 ]. …”

Section: Resultsmentioning

confidence: 99%

Fibrin Sealants in Dura Sealing: A Systematic Literature Review

Esposito

Angileri

Kruse³

et al. 2016

PLoS ONE

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“…In trans-sellar pituitary surgery good results have been demonstrated with free mucosal flaps [92], [93]. Furthermore, the expenditure of time to prepare pedicled flaps can be quite high and there is also a risk to induce additional postoperative morbidity by using these techniques.…”

Section: Techniques For Reconstruction In Endonasal Skull Base Surmentioning

confidence: 99%

The transnasal approach to the skull base. From sinus surgery to skull base surgery

Wagenmann,

Schipper

2011

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 10:Doc08; ISSN 1865-1011

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“…Resorbable natural-based polymeric implants seem to be best able to replicate the physiological composition of dura mater and to guarantee a natural scaffold for integration and replacement of the entire graft with normal dura mater. Collagen is most promising polymer for dura mater substitute [18].…”

Section: Introductionmentioning

confidence: 99%

Structural and biological evaluation of new chitosan membrane for dural closure

2019

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Materials and methods. Chitosan-based films were made out of 3% solution of chitosan for the research. We used 200, 500 and 700 kDa chitosan (deacetylation rate 80-90 %) to produce chitin-chitosan membrane by using solvent evaporation method. For enhancing mechanical properties and reducing the degradation, chitin particles were added to the chitosan solution. Chitosan and chitin ratio was 80/20. The chitin/chitosan solution in Petri dishes was dried out during 3 days at room temperature. To obtain information about the structure of membrane surface and crosssection scanning, electron microscopy was performed. Hydrolytic degradation was studied by pouring into SBF solution. To determine the rate of enzymatic degradation, trypsin solution was used. To determine the mass loss percentage, we measured the sample weight after 7, 14, 21, 30 and 60 days after being in the appropriate solutions. Relative elongation and strength were measured by digital dynamometer to study membranes mechanical properties such as the strength and elasticity. MLO-A5 cells were used to assess biocompatibility of new materials. Results. Macroscopic view of obtained samples has shown their relative transparency with impregnation of chitin particle that elevated over the membrane surface without any diversity between different chitosan molecular weight samples. Due to scanning electron microscopy, principal diversity between the samples of different molecular weight has being seen: rough pore surface at 200 and 500 kDa and flat with minimal roughness surface of 700 kDa membranes. Cross-section of 500 and 700 kDa membranes are dense with no pores, but 200 kDa membrane are sponge like and it can be prediction for fluid sorption and cell migration during healing process. Chitin-chitosan membranes are biocompatible and degrade in aqueous and enzymatic solutions. Due to polysaccharide nature of chitosan and chitin, enzymatic degradation has shown higher trend compare to the hydrolytic ones. 200 kDa membrane degrades faster with final mass loss 83.2 % and completely due to porous structure that allows fluid sorption. Membrane mechanical parameters strongly depend on their structure. 200 kDa membrane has shown 2-fold higher elongation compared to 500 kDa and 3-fold-compared to 700 kDa ones. The compensation of mechanical forces ensured by porous structure is better than in dense ones. Tensile strength was in 2-fold better in 200 kDa membranes than in 500 and 700 kDa ones. Cell culture experiment has shown the better adhesion at the 3 rd day for 200 kDa membrane and minimal cell adhesion for 700 kDa membrane, probably due to smooth surface. The reduction rate between all samples and PCT control differ a lot, except for 200 kDa membrane that has the same proliferation rate as TCP. Conclusion. Chitin-chitosan membranes, made from different molecular weight chitosan, are transparent and has appropriate structure for being used as a dura mater substitute. They are biocompatible and degrade in aqueous and enzymatic solutions. Due to porous structure, excel...

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Collagen-only biomatrix as a novel dural substitute

Cited by 53 publications

References 37 publications

Fibrin Sealants in Dura Sealing: A Systematic Literature Review

Fibrin Sealants in Dura Sealing: A Systematic Literature Review

The transnasal approach to the skull base. From sinus surgery to skull base surgery

Structural and biological evaluation of new chitosan membrane for dural closure

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