A CLINICOPATHOLOGICAL STUDY OF COLLAGEN SPONGE AS A DURAL GRAFT IN NEUROSURGERY

There is frequently a need for dural grafts to cover defects resulting from retraction, shrinkage, or excision following neurosurgical proce dures. Several materials have been evaluated both experimentally and c linically, and then discarded. Collagen, in its various forms, continu es to be an area of intense interest. In this study the authors examin ed the suitability of collagen sponge to effect dural repair. In a 5-y ear clinical study 102 collagen sponge implants were examined macrosco pically and histologically. Graft encapsulation, neomembrane formation , delayed hemorrhage, and foreign body reactions were not found. The p orous nature of the collagen sponge encouraged fibroblastic ingrowth a nd dural repair. Meningocerebral adhesions were present in 11 patients , all of whom had required significant cortical resection or had pia-a rachnoid disruption during the initial surgery. Inflammatory cells wer e seen only in response to infection. Postoperative cerebrospinal flui d leaks developed in only three of 67 patients who underwent an intrad ural posterior fossa procedure. In a prospective arm of the study invo lving 459 patients, the wound infection rate using collagen sponge was 6.1%, which compared favorably (p = 0.67) with the 5.7% rate in a sim ilar group of 637 patients in whom collagen sponge had not been used.