Sj. Palm et al., Dural closure with nonpenetrating clips prevents meningoneural adhesions: An experimental study in dogs, NEUROSURGER, 45(4), 1999, pp. 875-881
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.