Effect of expansive duraplasty on spinal cord injury in rat model

Objective:To explore the effect of expansive duraplasty on spinal cord injury in rat model.Methods:The 42 adult SD rats were randomly divided into contusion injury group(control group),durotomy group and expansive duraplasty group,each group included 12 rats and the remaining 6 rats were used to create dural allograft.The function of the hind limbs of the animals was evaluated by BBB score.Hematoxylin-eosin(HE)staining was employed for lesion volume measurements,Luxol Fast Blue(LFB)staining were used for white matter sparing and Immunohistochemistry(IHC)analysis was performed to detect the glial fibrillary acidic protein(GFAP)expression.Results:The BBB scores of rats in expansive duraplasty group were higher in comparison with contusion injury group on day 7 and 21 after surgery,the differences were statistically significant(P<0.05),the BBB scores of rats in expansive duraplasty group were higher in comparison with durotomy group on day 14 and 28 after surgery,the differences were statistically significant(P<0.05);lesion volume measurements showed a decrease in expansive duraplasty group relative to contusion injury group,and the differences were statistically significant(P<0.05),analysis of Integrated Optical Density(IOD)values showed that white matter sparing was higher in expansive duraplasty group compared with contusion injury group and durotomy group,and the differences were statistically significant(P<0.01),the average number of GFAP positive(+)cells in expansive duraplasty group was reduced when compared with the other two groups,and the differences were statistically significant(P<0.05).Conclusion:Our findings suggest that expansive duraplasty following spinal cord injury may improve motor functions of the rats,reduce lesion volume,inhibit demyelination and reduce connective tissue scar formation.

Decompressive Craniotomy and Fast-Track Duraplasty in Acute Subdural Hematomas

Background: Traumatic subdural hematoma is one of the severe injuries to brain with high mortality rates. Dural opening is often associated with brain herniation against the dural edges due to associated edema that would lead to venous infarction. Aim: The objective of this study is to describe a technical note that would allow fast and effective closure of the dura after hematoma evacuation via duraplasty with analysis of the safety and competency of the technique. Subjects and Methods: The fast-track technique was implemented in 15 successive cases with acute subdural hematoma where the fascia lata flap was prepared and sutured to the planned dural incision before opening the dura, which allowed fast and effective closure of the dura before brain herniation. Subdural bridges were planned by using Gelfoam to prevent venous compression. Analysis of the technique effectiveness was performed by the operative detection of brain herniation, as well as clinical and radiological follow-up of patients. Results: All patients had a Glasgow coma score (GCS) below six before the operation. Mean time from trauma to surgery was five hours. The dura could be effectively closed with no brain herniation in all cases. Nine patients survived (60%), where five of them ended up in a vegetative state. Of these two recovered and three continued in a persistent vegetative state. The mortality rate was 40%. Post-operative infarction was detected in post-operative imaging of four patients. Conclusion: The fast-track duraplasty technique is fast and effective in prevention of brain herniation during surgery with favorable clinical outcome in comparison with the poor and severely deteriorated preoperative clinical presentation. More studies to evaluate the impact of the technique on the survival rate are warranted.

Elevated intraspinal pressure in traumatic spinal cord injury is a promising therapeutic target

The currently recommended management for acute traumatic spinal cord injury aims to reduce the incidence of secondary injury and promote functional recovery.Elevated intraspinal pressure(ISP)likely plays an important role in the processes involved in secondary spinal cord injury,and should not be overlooked.However,the factors and detailed time course contributing to elevated ISP and its impact on pathophysiology after traumatic spinal cord injury have not been reviewed in the literature.Here,we review the etiology and progression of elevated ISP,as well as potential therapeutic measures that target elevated ISP.Elevated ISP is a time-dependent process that is mainly caused by hemorrhage,edema,and blood-spinal cord barrier destruction and peaks at 3 days after traumatic spinal cord injury.Duraplasty and hypertonic saline may be promising treatments for reducing ISP within this time window.Other potential treatments such as decompression,spinal cord incision,hemostasis,and methylprednisolone treatment require further validation.

Use of Acellular Fish Skin for Dura Repair in an Ovine Model: A Pilot Study

Recently the use of biologic materials as dura mater repair patches has been increasing. The purpose of this study is to assess the basis for efficacy and safety of using a novel fish derived acellular dermis (Kerecis Omega3 DuraTM). In an ovine model a craniotomy under general anaesthesia was performed. A defect was produced in the dural covering of approximately 1 × 2 cm and closed with an onlay technique, with Kerecis Omega3 Dura. The bone defect was covered with the bony flap and the overlying tissues closed in layers. At 2, 5, 8 and 11 weeks the sheep underwent MRI scanning followed by euthanasia, necropsy and histological assessment. MRI images taken at 2, 5, 8 and 11 weeks showed initially moderate inflammatory response, which diminished over time, and at 11 weeks no evidence of inflammation existed. There was evidence of cerebrospinal fluid leakage at no time point. Necropsy revealed some adhesions at 5 and 8 weeks, in particular at 5 weeks, but at 11 weeks there were no adhesions found. From 2 - 11 weeks, there was evidence of initially an inflammatory reaction followed by neodura formation at the defect site through cellular ingrowth and remodeling of the acellular fish skin. Histology showed a histiocytic foreign body reaction initially that subsided over time. As early as 8 weeks there was evidence of neodura formation and by 11 weeks there was a minimal inflammatory response with an intact neodura formed. In this pilot study the Kerecis Omega3 Dura patches performed in a safe and efficacious manner. This new material needs to be fully assessed and compared with other products that are currently on the market in a larger scale animal study.