Turchan Agus, Rochman Taufiq Fatchur, Ibrahim Arie, Fauziah Dyah, Wahyuhadi Joni, Parenrengi M Arifin, Fauzi Asra Al, Sufarnap Erliano, Bajamal Abdul Hafid, Suroto Heri, Rantam Fedik Abdul, Paramadini Adanti Wido, Lumenta Christianto Benjamin
Department of Neurosurgery, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia; Surabaya Neuroscience Institute, Surabaya, Indonesia.
Department of Neurosurgery, A. Wahab Sjahranie General Hospital, Mulawarman University, Samarinda, Indonesia.
J Clin Neurosci. 2018 Apr;50:272-276. doi: 10.1016/j.jocn.2018.01.069. Epub 2018 Feb 7.
In the field of neurosurgery, often the dura mater cannot be sutured, and consequently, it requires a duraplasty procedure using a dural fascial graft. Since 1890, various materials have been researched as dura mater substitutes. Amniotic membrane, for example, is suitable as a dural graft material and has been used in neurosurgery since 2012. However, there has been little research on human patient's dural healing after the use of amniotic membrane in their duraplasty procedure. To address this gap, a clinical experimental study was undertaken to evaluate the human dural healing of 16 patients who had undergone duraplasty in decompressive craniectomy surgery at Dr. Soetomo General Hospital, Surabaya. The amniotic membrane allograft, was sutured to cover the dural defect for eight randomly chosen patients (Group I). The fascial autograft from the temporal muscle had been applied for eight other patients (Group II). Between 10 and 20 weeks after surgery, the patients underwent cranioplasty and dural healing evaluation by cerebrospinal fluid (CSF) leakage testing through the edge of the dural defect. The fibrocyte infiltration around the edge of the dural defect was examined histologically. Statistical analysis, using an independent t-test, was performed with a confidence interval of 95%. The results of the clinical and histological analysis suggest that an amniotic membrane graft was able to provide watertight dural closure and adequate fibrocyte infiltration comparable with that provided by temporalis muscle fascia. This study shows that using an amniotic membrane in neurosurgery has a potential advantage over an alternative dural healing.
在神经外科领域，硬脑膜常常无法缝合，因此需要使用硬脑膜筋膜移植物进行硬脑膜成形术。自1890年以来，人们研究了各种材料作为硬脑膜替代物。例如，羊膜适合作为硬脑膜移植材料，自2012年起已用于神经外科手术。然而，关于在硬脑膜成形术中使用羊膜后人类患者硬脑膜愈合的研究很少。为了填补这一空白，在泗水苏托莫综合医院进行了一项临床实验研究，以评估16例在减压颅骨切除术硬脑膜成形术中接受治疗的患者的硬脑膜愈合情况。在随机选择的8例患者（第一组）中，缝合同种异体羊膜以覆盖硬脑膜缺损。另外8例患者（第二组）使用颞肌的自体筋膜。术后10至20周，患者接受颅骨成形术，并通过硬脑膜缺损边缘的脑脊液（CSF）渗漏测试进行硬脑膜愈合评估。对硬脑膜缺损边缘周围的成纤维细胞浸润进行组织学检查。采用独立样本t检验进行统计分析，置信区间为95%。临床和组织学分析结果表明，羊膜移植物能够提供防水的硬脑膜闭合，并且成纤维细胞浸润程度与颞肌筋膜相当。这项研究表明，在神经外科手术中使用羊膜比其他硬脑膜愈合方法具有潜在优势。
