-
Neurosurgical Review Jun 2024This Article provides a concise summary of the comprehensive exploration into the dura mater, dural tears, and the groundbreaking medical device, ArtiFascia® Dura... (Review)
Review
This Article provides a concise summary of the comprehensive exploration into the dura mater, dural tears, and the groundbreaking medical device, ArtiFascia® Dura Substitute. The neuroanatomy of the dura mater is elucidated, emphasizing its resilience and susceptibility to tears during spinal surgery. Dural repair methods are scrutinized, with research findings revealing the efficacy of primary closure with or without a patch.The introduction of ArtiFascia®, a nanofiber-based resorbable dural repair graft, represents a pivotal moment in neurosurgery. Obtaining 510(k) clearance from the FDA, ArtiFascia® demonstrates exceptional biological benefits, including enhanced cellular adhesion and tissue regeneration. The device's safety is affirmed through chemical analysis and toxicological risk assessment.The NEOART study, a randomized clinical trial involving 85 subjects across prominent European medical centers, validates ArtiFascia®'s superiority over existing dural substitutes. Noteworthy findings include exceptional graft strength, durability, and its ability to withstand physiological pressures.In conclusion, ArtiFascia® marks a revolutionary era in neurosurgery, promising safer and more effective solutions. This innovative device has the potential to elevate standards of care, offering both patients and surgeons an improved experience in navigating the complexities of neurosurgical procedures. The abstract encapsulates the key elements of the research, emphasizing the transformative impact of ArtiFascia® in the field.
Topics: Humans; Dura Mater; Neurosurgical Procedures; Neurosurgery; Nanofibers
PubMed: 38822140
DOI: 10.1007/s10143-024-02488-9 -
Sensors (Basel, Switzerland) Jun 2023Lumbar puncture is a minimally invasive procedure that utilizes a spinal needle to puncture the lumbar epidural space to take a sample from the cerebrospinal fluid or... (Review)
Review
Lumbar puncture is a minimally invasive procedure that utilizes a spinal needle to puncture the lumbar epidural space to take a sample from the cerebrospinal fluid or inject drugs for diagnostic and therapeutic purposes. Physicians rely on their expertise to localize epidural space. Due to its critical procedure, the failure rate can reach up to 28%. Hence, a high level of experience and caution is required to correctly insert the needle without puncturing the dura mater, which is a fibrous layer protecting the spinal cord. Failure of spinal anesthesia is, in some cases, related to faulty needle placement techniques since it is blindly inserted. Therefore, advanced techniques for localization of the epidural space are essential to avoid any possible side effects. As for epidural space localization, various ideas were carried out over recent years to provide accurate identification of the epidural space. Subsequently, several methodologies based on mechanical and optical schemes have been proposed. Several research groups worked from different aspects of the problem, namely, the clinical and engineering sides. Hence, the main goal of this paper is to review this research with the aim of remedying the gap between the clinical side of the problem and the engineering side by examining the main techniques in building sensors for such purposes. This manuscript provides an understanding of the clinical needs of spinal needles from an anatomical point of view. Most importantly, it discusses the mechanical and optical approaches in designing and building sensors to guide spinal needles. Finally, the standards that must be followed in building smart spinal needles for approval procedures are also presented, along with some insight into future directions.
Topics: Needles; Spinal Puncture; Anesthesia, Epidural; Anesthesia, Spinal; Central Nervous System
PubMed: 37447917
DOI: 10.3390/s23136065 -
Acta Biomaterialia Oct 2023The human dura mater is known to impact vastly traumatic brain injury mechanopathology. In spite of this involvement, dura mater is typically neglected in computational...
The human dura mater is known to impact vastly traumatic brain injury mechanopathology. In spite of this involvement, dura mater is typically neglected in computational and physical human head models. The lack of location-dependent microstructural and related mechanical data of dura mater may be considered a rationale behind this simplification. The anisotropic nature of dura mater under various loading conditions so far remains unelucidated. Furthermore, principal collagen fiber orientation is yet to be quantified for a morpho-mechanically-informed material model on the dura mater. This study aims to assess how location-dependent mechanical anisotropy is linked to principal collagen fiber orientation. Uniaxial extension tests were performed in a heated tissue bath for 60 samples from six individuals and correlated to the three-dimensional collagen structure in four individuals using second-harmonic generation (SHG) imaging. Failure stress and stretch at failure, elastic modulus, and a microstructurally motivated material model were integrated to examine local differences in dura mater morpho-mechanics. The quantitative observation of collagen fiber orientation and dispersion confirmed that collagen is highly aligned in the human dura mater and that both fiber orientation and dispersion differ depending on the location investigated. This observation provides a possible explanation for the previously observed isotropic mechanical behavior, as the main collagen fiber direction is not oriented along the anterior-posterior or medial-lateral direction at most of the mapped locations. Additionally, these site-dependent structural properties have implications for the mechanical load response and therefore potentially for the regional functions dura mater has to fulfill. The here chosen non-symmetrical fiber dispersion material model fits the data well and provides a comprehensive parameter base for further studies and future finite element models. STATEMENT OF SIGNIFICANCE: The human dura mater greatly affects traumatic brain injury mechanisms, but it is often ignored in computational and physical head models. This is because there is a lack of detailed microstructural and mechanical data specific to the dura mater. Its anisotropic nature and collagen fiber orientation have not been fully understood, hindering the development of an accurate material model. Hence, this study combines morphological data on collagen fiber orientation and dispersion at multiple locations of human cranial dura mater, and links microstructure to location-specific load-displacement behavior. It provides microstructurally informed mechanical information towards realistic head models for predicting location-dependent tissue behavior and failure for assessing brain injury and graft material development.
PubMed: 37598794
DOI: 10.1016/j.actbio.2023.08.024 -
World Neurosurgery Aug 2023Adequate epidural procedures and anatomical knowledge are essential for the technical success of skull base surgery. We evaluated the usefulness of our three-dimensional...
BACKGROUND
Adequate epidural procedures and anatomical knowledge are essential for the technical success of skull base surgery. We evaluated the usefulness of our three-dimensional (3D) model of the anterior and middle cranial fossa as a learning tool in improving knowledge of anatomy and surgical approaches, including skull base drilling and dura matter peeling techniques.
METHODS
Using a 3D printer, a bone model of the anterior and middle cranial fossa was created based on multi-detector row computed tomography data, incorporating artificial cranial nerves, blood vessels, and dura mater. The artificial dura mater was painted using different colors, with 2 pieces glued together to allow for the simulation of peeling the temporal dura propria from the lateral wall of the cavernous sinus. Two experts in skull base surgery and 1 trainee surgeon operated on this model and 12 expert skull base surgeons watched the operation video to evaluate this model subtlety on a scale of 1 to 5.
RESULTS
A total of 15 neurosurgeons, 14 of whom were skull base surgery expert, evaluated, scoring 4 or higher on most of the items. The experience of dural dissection and 3D positioning of important structures, including cranial nerves and blood vessels, was similar to that in actual surgery.
CONCLUSIONS
This model was designed to facilitate teaching anatomical knowledge and essential epidural procedure-related skills. It was shown to be useful for teaching essential elements of skull-base surgery.
Topics: Humans; Cranial Fossa, Middle; Skull Base; Dura Mater; Neurosurgical Procedures; Cranial Nerves
PubMed: 37270099
DOI: 10.1016/j.wneu.2023.05.105 -
Macromolecular Bioscience Oct 2023The dura mater is the final barrier against cerebrospinal fluid leakage and plays a crucial role in protecting and supporting the brain and spinal cord. Head trauma,...
The dura mater is the final barrier against cerebrospinal fluid leakage and plays a crucial role in protecting and supporting the brain and spinal cord. Head trauma, tumor resection and other traumas damage it, requiring artificial dura mater for repair. However, surgical tears are often unavoidable. To address these issues, the ideal artificial dura mater should have biocompatibility, anti-leakage, and self-healing properties. Herein, this work has used biocompatible polycaprolactone diol as the soft segment and introduced dynamic disulfide bonds into the hard segment, achieving a multifunctional polyurethane (LSPU-2), which integrated the above mentioned properties required in surgery. In particular, LSPU-2 matches the mechanical properties of the dura mater and the biocompatibility tests with neuronal cells demonstrate extremely low cytotoxicity and do not cause any negative skin lesions. In addition, the anti-leakage properties of the LSPU-2 are confirmed by the water permeability tester and the 900 mm H O static pressure test with artificial cerebrospinal fluid. Due to the disulfide bond exchange and molecular chain mobility, LSPU-2 could be completely self-healed within 115 min at human body temperature. Thus, LSPU-2 comprises one of the most promising potential artificial dura materials, which is essential for the advancement of artificial dura mater and brain surgery.
PubMed: 37222304
DOI: 10.1002/mabi.202300111 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024The article presents a case of idiopathic hypertrophic pachymeningitis of a 61-year-old male patient with severe cephalgia and progressive neuropathy of the oculomotor...
The article presents a case of idiopathic hypertrophic pachymeningitis of a 61-year-old male patient with severe cephalgia and progressive neuropathy of the oculomotor nerves. The diagnosis was confirmed by MRI with gadolinium, which revealed thickening of the dura mater with accumulation of paramagnetic in the convexital parts of the frontal and temporal regions, as well as on the base of the skull and tentorium. During the use of pulse therapy with glucocorticosteroids (GCS) the symptoms regressed, but when the therapy was stopped, there was a relapse of ptosis and oculomotor abnormalities on the other side followed by a slower effect of GCS therapy. The article also presents a brief review of current knowledge about this pathology.
Topics: Male; Humans; Middle Aged; Skull; Meningitis; Magnetic Resonance Imaging; Hypertrophy
PubMed: 38529871
DOI: 10.17116/jnevro2024124031114 -
Journal of the History of the... 2023In contemporary neurosurgery little attention is currently paid to the pericranium. The purpose of this article is to present how past surgeons have viewed this membrane...
In contemporary neurosurgery little attention is currently paid to the pericranium. The purpose of this article is to present how past surgeons have viewed this membrane and how they have reacted to its appearances. In ancient times, the pericranium was considered formed by the dura through the sutures and it retained a relationship with the dura via vessels in the sutures. It was considered advisable to strip it totally from any area to be examined for fissure fractures and also for any area to be trepanned, as pericranial injury led to fever and inflammation. In the eighteenth century, a new idea arose that posttraumatic spontaneous separation of the pericranium from the bone was a reliable indicator of the development of intracranial suppuration. This idea was subsequently refuted. The development of the osteoplastic bone flap imposed on the surgeon the need to ensure postoperative craniotomy closure included accurate apposition of the margins of the pericranium. With modern free bone flaps, this is no longer required. For over two millenia, the pericranium was considered to be an important membrane requiring the close attention of the surgeon. It is no longer required to receive more than minimal attention.
Topics: Humans; Craniotomy; Neurosurgical Procedures; Trephining; Dura Mater; Surgeons
PubMed: 37641397
DOI: 10.1080/0964704X.2023.2229390