Repair of spinal dural defects with vicryl (polyglactin 910) mesh

Area of Science:

• Neurosurgery
• Biomaterials Science
• Regenerative Medicine

Background:

• Spinal dural defects pose significant challenges in neurosurgery.
• Effective dural substitutes are crucial for preventing complications like cerebrospinal fluid leakage and pseudo-meningoceles.
• Current options may have limitations, necessitating evaluation of novel materials.

Purpose of the Study:

• To compare the efficacy of woven vicryl (polyglactin 910) mesh against lyophilized cadaver dura (Lyodura) for spinal dural defect repair.
• To assess the biocompatibility and regenerative potential of vicryl mesh as a dural substitute.
• To evaluate the incidence of complications associated with each repair method.

Main Methods:

• A prospective study involving 16 mongrel dogs with surgically created spinal dural defects.
• Repair of defects using woven vicryl mesh, with contralateral dural incisions closed by vicryl suture as an internal control.
• Histological and macroscopic evaluation of repair sites at 4, 8, 12, and 24 weeks post-surgery.

Main Results:

• Successful dural defect repair was achieved in all animals, irrespective of the material used.
• No instances of pseudo-meningocele, cerebrospinal fluid leakage, or postoperative infection were observed.
• Vicryl mesh facilitated neodural membrane formation with minimal inflammatory response and no neural adhesions.
• Lyodura resulted in thicker neodural membranes but was associated with significant arachnoid-neural adhesions in some cases.

Conclusions:

• Woven vicryl mesh is a suitable and promising alternative for spinal dural repair.
• Vicryl mesh demonstrates excellent biocompatibility and promotes regeneration without adverse neural tissue reactions.
• Compared to Lyodura, vicryl mesh offers a potentially safer option by minimizing the risk of neural adhesions.