Dural closure with nonpenetrating clips prevents meningoneural adhesions: An experimental study in dogs

OBJECTIVE: Meningospinal and cranial dural adhesions were compared in a can ine model, after duraplasty using nonpenetrating clips or penetrating needl es and sutures. METHODS: Fourteen dogs underwent bilateral craniotomies and duraplasties, w ith implantation of dural prostheses (DuraGuard; Biovascular Corp., Minneap olis, MN), using either 6-0 silk sutures or titanium clips (DuraClose; Surg ical Dynamics, Norwalk, CT). Fourteen other dogs underwent L3-L4 laminectom ies; three longitudinal dural incisions were closed with 6-0 silk sutures, 6-0 polyglactin 910 (Vicryl) sutures, or clips. Groups of eight dogs (four cranially treated and four spinally treated) were killed 6, 12, 24, and 52 weeks after surgery, and specimens were collected for study after perfusion and fixation (two cranial and two spinal dural reconstructions at 52 wk). Evaluations included assessment of the appearance of approximated dural mar gins and responses to clips, sutures, and dural prostheses (inflammation, f oreign body reaction, fibrosis, and severity of meningospinal/meningocerebr al adhesions). Data were evaluated using the Wilcoxon signed-rank and McNem ar tests. RESULTS: Duraplasties with clips displayed significantly less extensive acu te and chronic inflammation, foreign body reaction, and meningoneural adhes ions than did repairs with needles and sutures. CONCLUSION: This report is the first long-term experimental study comparing two fundamentally different methods for dural repair in a relevant animal model.