Human Dura Mater Reconstruction With Grafts: A Comparative Study of Dural Closure by Duraplasty Using Human Pericranium and Dura Mater Under Variable Hydrostatic Conditions

Introduction:

Introduction: Partial excision of the meninges during neurosurgical procedures is essential for access to the intracranial cavity, requiring subsequent dural repair. The demand to correct these injuries has driven the use of dural grafts. Autologous pericranium is an alternative in providing a suitable surface for fusion with the patient's dura, and autologous dura mater can be replaced for the same purpose.

Methods:

Methods: Six experimental groups, each with four samples of human dura mater, were prepared with excision of 1 cm x 1 cm in each sample. The pericranium or dura mater was implanted to restore the injury, fixed by continuous suture with 4-0 Prolene thread and a 19 mm needle, ⅜ format. The samples were then exposed to different levels of hydrostatic pressure (10, 20, and 40 cm H2O) using 0.9% NaCl to measure the volume of extravasated fluid. Data were analyzed with mean ± standard deviation and significance of p< 0.05.

Results:

Results: In the group that received dura mater as a graft in duraplasty, fluid extravasation (ml/5 min) was observed at the following pressures: 10 cm H2O, mean 2.28 ± 1.36; 20 cm H2O mean 9.35 ± 6.21; 40 cm H2O mean 21.98 ± 15.86. In the group that received pericranium, the following were observed: 10 cm H2O, mean 25.90 ± 5.25; 20 cm H2O mean 54.03 ± 5.68; 40 cm H2O mean 118.5 ± 10.08. It was found that the pericranium is more easily injured by the needle incision, which makes the leak greater.

Conclusion :

Conclusion: Duroplasty with pericranium resulted in the greatest amount of extravasated fluid compared to dura mater as a graft.