Review of dura mater substitutes in neurosurgical practice

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Abstract

AIM: This study aimed to summarize the accumulated experience and compare available materials for the plasty of dura mater (DM) defects. The growing number of patients with craniocerebral traumas and an increasing amount of neurological surgeries for tumor processes and congenital malformations resulted in an increased amount of DM defects and associated complications. Despite the development of high-efficiency medical products, the percentage of postsurgical CSF leakage remains high and reaches 32% in case the defect is in infratentorial locations. Suitable substitute materials should be developed for the repair of dural defects because of complications such as pseudomeningocele, postsurgical inflammatory processes, CSF leakage, implant rejection, and cicatrical adhesion. In this article, basic materials, including auto- and allografts, biological substances, and synthetic materials, for the repair of dural defects were reviewed. Their positive and negative properties depending on the kind and location of lesions and on the type of material used were discussed. The main characteristics to be fulfilled by an ideal dura mater substitute were analyzed. Composite materials were considered a promising trend in modern bioengineering.

CONCLUSION: An ideal material for the repair of DM defects should have the following properties: plastic, nonimmunogenic, watertight, highly porous, high surface area of fibers, cell growth stimulating, supportive for the survival of cells until they completely integrate with host tissues, conveniently replaceable, and adhesive. No ideal transplant materials can meet all the above demands. Biological, synthetic, and host tissues only supplement one another. Relevant studies have yet to be performed to obtain a more versatile and time and cost effective material that can satisfy all the requirements of modern neurosurgery. The existing results of preclinical studies have demonstrated that composite materials are similar to synthetic materials in terms of the strength and properties of biological tissues for the migration and proliferation of cells. In the future, they may become a promising alternative to biological substitutes.

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About the authors

Roni B. Mai

M.F. Vladimirsky Moscow Scientific Research Clinical Institute

Author for correspondence.
Email: doctor.ronimai@gmail.com
ORCID iD: 0000-0002-1376-390X
SPIN-code: 1403-3063

Researcher of Pediatric Surgery Department

Russian Federation, Moscow

Vladimir E. Popov

M.F. Vladimirsky Moscow Scientific Research Clinical Institute

Email: doctor.ronimai@gmail.com
ORCID iD: 0000-0003-4835-8047

MD, Cand.Sci. (Med.), Chief Freelance Specialist in Pediatric Neurosurgery of the Moscow Region Ministry of Health, Senior Researcher of the Pediatric Surgery Department

Russian Federation, Moscow

Egor O. Osidak

OOO Imtek

Email: egorosidak@gmail.com
ORCID iD: 0000-0003-2549-4011

MD, Cand.Sci.(Biol.), Leading Researcher

Russian Federation, Moscow

Sergey P. Domogatsky

National Medical Research Institute of Cardiology

Email: spdomo@yandex.ru
ORCID iD: 0000-0002-6527-2440

MD, Cand.Sci.(Biol.), Leading Researcher of the Immunochemistry Laboratory of the Experimental Cardiology Research Institute, National Medical Research Institute of Cardiology

Russian Federation, Moscow

Aleksandr E. Nalivkin

M.F. Vladimirsky Moscow Scientific Research Clinical Institute

Email: surgnal@yandex.ru

MD, Dr.Sci.(Med.), Professor of the Surgery Department, Head of Pediatric Surgery Department

Russian Federation, Moscow

Ekaterina S. Mishina

Kursk State Medical University

Email: katusha100390@list.ru
ORCID iD: 0000-0003-3835-0594

MD, Cand.Sci.(Med.), Associate Professor of the Histology, Embryology, Cytology Department

Russian Federation, Kursk

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Copyright (c) 2021 Mai R., Popov V., Osidak E., Domogatskij S., Nalivkin A., Mishina E.


Media Registry Entry of the Federal Service for Supervision of Communications, Information Technology and Mass Communications (Roskomnadzor) PI No. FS77-76803 dated September 24, 2019.



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