Original article Nanofiber nets in prevention of cicatrisation in spinal procedures. Experimental study

Abstract

Folia Neuropathologica 2013; 51/2 147 Nanofiber nets in prevention of cicatrisation in spinal procedures. Experimental study J Ja ar ro os sł ła aw w A An nd dr ry yc ch ho ow ws sk ki i 1 1, ,2 2 , , M Ma ał łg go or rz za at ta a F Fr ro on nt tc cz za ak k--B Ba an ni ie ew wi ic cz z A b s t r a c t Excessive cicatrisation or epidural fibrosis in the operative field is an inappropriate event occasionally occurring after neurosurgical procedures (i.e., spine procedures and craniotomies). This excessive process may disturb the postoperative course and render reoperations more difficult and risky. The literature describes this phenomenon as accompanying up to 20% of neurosurgical procedures. The scar tissue that forms postoperatively adheres to the dura mater, penetrates into the spinal canal and can cause narrowing symptoms, neurological deficits and pain. The incidence and spread of this excessive scar or epidural fibrosis can be prevented through the modification of the surgical technique by incorporating endoscopic or microscopic access to minimize the operative field and the use of isolating substances (autogenous or heterogeneous) administered intraoperatively. The aim of this experimental study was to morphologically assess the cicatrisation process, adhesion and to prevent excessive scar formation with the local use of membranes manufactured by an electrospinning process (nanotechnology). We also investigated whether the biodegradable nanofibrous net triggers or modifies the immunological response or the local inflammatory process. Micro-nanofibrous membranes were produced by the electrospinning process. A biodegradable, medically certified copolymer poly(L-lactide-co-caprolactone) (PLCL) was IntroductionThe first papers on cicatrisation or the process of epidural fibrosis after neurosurgical procedures date back to the 1970s [4,26,27,43]. Developments and progress in the field of spinal surgery have caused the number of patients undergoing these procedures to multiply [4]. Long-term postoperative observations have demonstrated excessive cicatrisation within the spinal canal and its dural and neural components to be one of the factors adversely affecting the postoperative period [10,26,28,30,41,42]. We observed this improper cicatrisation involving the neural elements after the dura and arachnoid matter damage in the different neurosurgical procedures. Epidural fibrosis is considered to be one of the mechanisms that may be responsible for postoperative pain [30,41,42]. Cicatrisation is a part of the natural and normal healing process that makes any surgery possible, but excessive or inappropriate scar formation is an adverse process in the surgical context.In neurosurgery, excessive cicatrisation can lead to neurological symptoms and pain. Its prevention is based on three methods specifically designed to significantly reduce epidural fibrosis, adhesion and/or excessive cicatrisation. The first method is based on minimizing the surgical field exposure using microscopic and endoscopic approaches [16,27...

Original article Non-woven nanofiber mats – a new perspective for experimental studies of the central nervous system?

“…The absence of similar damage in the rats carrying "empty" nanofiber mat implants demonstrated that the PLCL mat itself was safe for the spinal cord and did not cause mere mechanical contact/size-related irritation either. The latter observation is in line with earlier studies performed in Mossakowski Medical Research Centre [1,24].…”

“…The surgical procedure employed for submeningeal implantation of nanofiber mat pieces (approximately 5 mm × 5 mm size) into rat spinal cords (at the lumbar enlargement level) was as described elsewhere [1]. Three weeks after implantation of nanofiber mats, all rats were anesthetized with a lethal dose of sodium pentobarbital (80 mg/kg, i.p.)…”

“…A considerable potential for such applications is shown by nanofibers made of polycarbonates or aliphatic polyesters, which degrade in vivo relatively slowly (over many weeks, see [9]) by non-enzymatic random hydrolytic scission of esters linkage, to form small molecules identical to or homologous with endogenous metabolites or their analogs; the process is slow enough to cause no inflammation. Nanofibers made of these polymers can also aid appropriate healing of possible CNS trauma [1,24], which is likely due to their forming a temporary biocompatible scaffold for the cells taking part in this process [5].…”

Use of spongostan on prevention of cranial subdural adhesions following craniotomy in a rabbit model

“…clinical and experimental reports is mainly prevention of epidural fibrosis (2,5,8,10,19,23,27). Fibrosis is not only a problem in spinal operations but also a problem in cranial operations like cerebellopontine angle and posterior fossa tumors, cranioplasty or treatment of intracranial infections (12, 14, 16).…”

Nanofiber mat spinal cord dressing-released glutamate impairs blood-spinal cord barrier

“…Subarachnoidal implantation of nanofiber mat pieces (5 × 5 mm size) into rat spinal cords (at the lumbar enlargement level) was performed as described earlier [1]. Three weeks after the surgery, all rats were deeply anesthetized with pentobarbital (80 mg/kg, i.p.)…”