A novel equine-derived pericardium membrane for dural repair: A preliminary, short-term investigation

Abstract

Background: A large variety of biological and artificial materials are employed in dural repair, each of them with major limitations. Autologous grafts have limited availability and require an additional incision and surgical time. Cadaveric preparations and heterologous materials entail the risk of iatrogenic transmission of prions, whereas synthetic substitutes have been reported to cause inflammatory reactions and graft rejection. An equine-derived pericardium membrane has been developed (Heart(®), Bioteck, Vicenza, Italy) with mechanical and safety-related features that could make it suitable for neurosurgical application.

Aims: This preliminary study aimed to evaluate the short-term safety and efficacy of the Heart(®) membrane in dural repair procedures following meningioma surgeries.

Subjects and methods: Medical records of patients who were surgically treated for an intracranial meningioma and underwent duraplasty with the Heart(®) membrane were reviewed retrospectively. The occurrence of any graft-related complications such as cerebrospinal fluid (CSF) leakage, postoperative hematoma, wound infection, meningitis, and neurological symptoms was analyzed.

Results: Eight patients were identified as meeting the inclusion criteria. A watertight closure was achieved in all of them. Postoperatively, no patients exhibited CSF leak, cerebral contusion, hemorrhage, or wound infection. The 1-month radiological follow-up revealed no evidence of pseudomeningocele, wound breakdown, or meningitis. Neurologic complications were observed in three patients but not directly imputable to the dural substitute or its application.

Conclusions: In all the patients, the pericardium membrane enabled achievement of a watertight dural closure without graft-related adverse events. Further investigations should be performed to assess medium- and long-term clinical outcomes in a larger set of patients.

Keywords: Dural substitute; duraplasty; equine pericardium; xenograft.

Figure 1

Application of the Heart^® membrane as a dural substitute. After positioning over the defect (a), the membrane is cut back to appropriate dimensions (b) and sutured to the patient's dura mater (c)