Mohammed Kazim, Iqbal Javeed, Arshad Mohsin, Abu-Dayeh Ala Saleem, Albozom Issam, Alyafei Abdulnasser, Ben Zabih Tarek, Belkhair Sirajeddin
Department of Neurosurgery, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar; Department of Neurosurgery, University of Qatar, Doha, Qatar.
Department of Neurosurgery, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar.
World Neurosurg. 2023 Apr;172:e585-e592. doi: 10.1016/j.wneu.2023.01.089. Epub 2023 Feb 7.
Though the indications are quite varied, decompressive craniectomy is considered a life-saving procedure. Maximal effectiveness of craniectomy is achieved when, in addition to bone removal, the dura mater is opened properly and is augmented with duraplasty. Different synthetic materials have been used over the decades to replace the dura during decompressive craniectomy. We have used different synthetic dural replacements at our institution, including Neuro-Patch, DuraGen, and Lyoplant. In this case series, we described 4 cases that had excessive granulation tissue formation in response to a newly used synthetic dural substitute (ReDura) after emergent decompressive craniectomy. During follow-up brain imaging at different intervals, these cases were found to have foreign body reaction in the form of excessive granulation tissue formation; additionally, 1 case had a sterile pus-like collection. The granulation tissue diagnosis was affirmed by histopathology in all 4 cases.
This study was an observational retrograde case series, with data obtained from electronic medical records.
The study showed extensive foreign body giant cell reactions on preoperative computed tomography scans, indicating a very high occurrence rate of 72.4%, when ReDura was used as dural replacement.
Our experience showed that patients are prone to develop severe foreign body giant cell reactions with ReDura. Neurosurgical centers using this material should monitor patients for possible abnormal foreign body reaction and report it to establish the safety and efficacy profile of this material.
尽管减压性颅骨切除术的适应证多种多样，但它被认为是一种挽救生命的手术。当除了去除颅骨外，还正确打开硬脑膜并进行硬脑膜成形术时，颅骨切除术能达到最大效果。几十年来，在减压性颅骨切除术中使用了不同的合成材料来替代硬脑膜。我们机构使用过不同的合成硬脑膜替代品，包括Neuro-Patch、DuraGen和Lyoplant。在这个病例系列中，我们描述了4例在急诊减压性颅骨切除术后对一种新使用的合成硬脑膜替代品（ReDura）出现过度肉芽组织形成的病例。在不同间隔的随访脑部成像中，发现这些病例出现了以过度肉芽组织形成为形式的异物反应；此外，1例有类似无菌脓液的积液。所有4例病例的肉芽组织诊断均经组织病理学证实。
本研究是一项观察性回顾性病例系列研究，数据来自电子病历。
研究显示，当使用ReDura作为硬脑膜替代品时，术前计算机断层扫描显示广泛的异物巨细胞反应，发生率非常高，为72.4%。
我们的经验表明，使用ReDura的患者容易出现严重的异物巨细胞反应。使用这种材料的神经外科中心应监测患者是否可能出现异常异物反应，并进行报告，以确定该材料的安全性和有效性。
