Splavski Bruno, Frol Senta
Department of Neurosurgery, Dubrovnik General Hospital, Dubrovnik, HRV.
Department of Anatomy, Faculty of Applied Health Sciences, University of Zagreb, Zagreb, HRV.
Cureus. 2025 Jun 21;17(6):e86487. doi: 10.7759/cureus.86487. eCollection 2025 Jun.
Dural repair following an osteoplastic craniotomy presents significant challenges, necessitating an optimal dural substitute to avoid complications and ensure successful patient outcomes when primary dural closure is not possible. Ideal substitutes provide a scaffold for fibroblast migration and implantation, which are essential for achieving postoperative dural sealing and watertightness. However, such a substitute seldom exists, underscoring the importance of choosing appropriate materials for dural repair to reduce the risks of postoperative complications, including iatrogenic prion contamination that may promote intracranial amyloid transmission. Available dural substitutes are categorized into autologous, allogeneic, and xenogeneic transplants, as well as organic, synthetic, and composite polymer grafts. While each category offers specific benefits, many disadvantages persist, including the risks of prion-like amyloid protein deposition, particularly spreading iatrogenic Creutzfeldt-Jakob disease. These risks have historically been associated with the use of cadaveric dura grafts and prion-contaminated surgical instruments, necessitating safer replacement materials and enhanced sterilization protocols. This narrative review addresses the critical challenges of dural repair following cranial surgery, proposing innovative directions that include the use of composite materials and emerging technologies, such as 3D printing. Through a narrative review, the evaluation of traditional and advanced dural substitutes is provided, summarizing the advantages and limitations of currently available dural substitutes. In conclusion, the ideal dural substitute should closely replicate the natural structure of the dura, support tissue regeneration, and prevent postoperative complications such as cerebrospinal fluid leakage and intracranial iatrogenic amyloid transmission, thereby ensuring optimal patient outcomes and recovery.
骨成形开颅术后的硬脑膜修复面临重大挑战，因此在无法进行一期硬脑膜闭合时，需要一种理想的硬脑膜替代物来避免并发症并确保患者获得成功的治疗结果。理想的替代物为成纤维细胞迁移和植入提供支架，这对于实现术后硬脑膜密封和防水至关重要。然而，这样的替代物很少存在，这凸显了选择合适的硬脑膜修复材料以降低术后并发症风险的重要性，这些并发症包括可能促进颅内淀粉样蛋白传播的医源性朊病毒污染。现有的硬脑膜替代物分为自体、同种异体和异种移植，以及有机、合成和复合聚合物移植物。虽然每一类都有特定的优点，但许多缺点仍然存在，包括朊病毒样淀粉样蛋白沉积的风险，特别是传播医源性克雅氏病。这些风险在历史上一直与使用尸体硬脑膜移植物和受朊病毒污染的手术器械有关，因此需要更安全的替代材料和强化的消毒方案。本叙述性综述探讨了颅脑手术后硬脑膜修复的关键挑战，提出了创新方向，包括使用复合材料和新兴技术，如3D打印。通过叙述性综述，对传统和先进的硬脑膜替代物进行了评估，总结了目前可用硬脑膜替代物的优点和局限性。总之，理想的硬脑膜替代物应紧密复制硬脑膜的自然结构，支持组织再生，并预防术后并发症，如脑脊液漏和颅内医源性淀粉样蛋白传播，从而确保患者获得最佳的治疗结果和康复情况。
