Collagen vicryl--a new dural prosthesis

No ideal dural grafting material is currently available. Many materials have been evaluated in this role, and for many neurosurgeons cadaveric human lyophilized dura has been popular. Recently this material has been putatively associated with Creutzfeldt-Jakob disease. In this study we compared three degradable materials, collagen vicryl (Bovine collagen coated vicryl mesh), Zenoderm (Porcine dermis) and Lyodura (Lyophilized human cadaveric dura) as dural substitutes. In an experimental model using the New Zealand White Rabbit the materials were implanted into dural defects of dimensions 1.7 cm by 1 cm. In the control group the dura was not repaired. In total 47 animals were used and sacrificed at time intervals of 2, 4, 8, 12, and 24 weeks. On gross examination the collagen vicryl produced few adhesions to the cerebral cortex and was replaced by a neomembrane which showed good union with the host dura. In the control group no new layer was formed and there were severe cortical adhesions. Zenoderm and Lyodura remained undegraded and produced more adherence to the cerebral cortex than the collagen vicryl implant. The histological examination showed collagen vicryl to support ingrowth of fibroblasts and the production of a new collagen layer which by 3 months resembled the original host dura. The inflammatory response to the implant did not persist after 3 months. The other substitutes were revitalized by host cells but remained undegraded at 6 months with ingrowth of woven bone and persistence of inflammatory and foreign body response. The results show collagen vicryl to be a suitable dural substitute with potential advantages over other currently used degradable materials, and should be evaluated more fully, both in laboratory studies and clinically.