Mello L R, Feltrin L T, Fontes Neto P T, Ferraz F A
Medical School, Universidade Regional de Blumenau, Santa Catarina, Brazil.
J Neurosurg. 1997 Jan;86(1):143-50. doi: 10.3171/jns.1997.86.1.0143.
In the search for a new synthetic substitute for the dura mater, the authors conducted a research study using 32 mongrel dogs divided into three groups. Group I animals (21 dogs) underwent a right-sided parietooccipital craniotomy and substitution of two 1-cm pieces of dura mater by two different grafts: one piece of biosynthetic cellulose (50 mu thick) and one fragment of temporal fascia. The animals were observed for 30, 90, or 180 days. Group II animals (five dogs) underwent a somewhat larger craniotomy, removal of a 2-cm piece of dura mater, and lesioning of the cortex made by a thin sharp forceps, which caused bleeding that was controlled by application of a thin film of cellulose (10 mu thick). Duraplasty was performed using a 50-mu-thick cellulose membrane to complete the procedure and the animals were observed over a period of 270 days. Group III animals (six dogs) underwent smaller (1-cm diameter) bilateral parietal craniectomy, which included additional covering of the dura on the left side with 50-mu-thick cellulose and a suture of temporalis muscle. This group was observed for 40, 60, 80, or 120 days. Transient mild clinical symptoms were observed during the early postoperative period. At autopsy, macroscopic examination demonstrated good acceptance of the grafts with few and moderate extradural fibrosis, which caused adherence of the implants to the bone fragment. No adherence to the cortex was observed. Microscopic examination demonstrated absence of graft adherence to the cortical surface even when the cortex was injured. The cellulose was enveloped by two layers of connective tissue, the external layer being thicker than the internal one. Cellulose fibers increased in thickness over time until 30 days and then decreased in thickness until 270 days. This decrease in thickness between 30 to 270 days was statistically significant (p < 0.05). The physical properties of biosynthetic cellulose and the low cellular reaction to its implantation qualify this material as a dural substitute. Additional long-term studies must be undertaken to complete this report.
在寻找一种新的硬脑膜合成替代品的过程中，作者使用32只杂种狗进行了一项研究，将其分为三组。第一组动物（21只狗）接受了右侧顶枕开颅手术，并用两种不同的移植物替代两块1厘米的硬脑膜：一块生物合成纤维素（50微米厚）和一块颞筋膜。对这些动物进行30天、90天或180天的观察。第二组动物（5只狗）接受了稍大的开颅手术，切除了一块2厘米的硬脑膜，并用薄而锋利的镊子对皮质进行损伤，导致出血，通过应用一层薄的纤维素膜（10微米厚）来控制出血。使用50微米厚的纤维素膜进行硬脑膜成形术以完成该手术，并对动物进行270天的观察。第三组动物（6只狗）接受了较小的（直径1厘米）双侧顶骨颅骨切除术，其中包括用50微米厚的纤维素对左侧硬脑膜进行额外覆盖以及颞肌缝合。对该组动物进行40天、60天、80天或120天的观察。术后早期观察到短暂的轻度临床症状。尸检时，宏观检查显示移植物接受良好，硬膜外纤维化较少且程度适中，这导致植入物与骨碎片粘连。未观察到与皮质的粘连。显微镜检查显示，即使皮质受损，移植物也未与皮质表面粘连。纤维素被两层结缔组织包裹，外层比内层厚。纤维素纤维的厚度在30天前随时间增加，然后在270天前厚度减小。30至270天之间厚度的这种减小具有统计学意义（p < 0.05）。生物合成纤维素的物理特性及其植入后的低细胞反应使这种材料成为一种硬脑膜替代品。必须进行更多的长期研究来完善本报告。
