Homologous amniotic membrane as a dural substitute in decompressive craniectomies. (July 2021)

• Record Type: Journal Article
• Authors: Marton, Elisabetta; Giordan, Enrico; Gallinaro, Paolo; Curzi, Christian; Trojan, Diletta; Paolin, Adolfo; Guerriero, Angela; Rossi, Sabrina; Bendini, Matteo; Longatti, Pierluigi; Canova, Giuseppe
• Is Part Of: Journal of clinical neuroscience. Volume 89(2021)
• Page Start: 412
• Page End: 421
• Publication Date: 2021-07
• Subjects: Amniotic membrane -- Trauma -- Neuro -- Decompressive -- Craniectomy -- Cranioplasty -- Intracranial pressure; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2021.05.030
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: The properties of the amniotic membrane (AM) are ideal for its use as a dural substitute. AM patches can be processed and stored at low costs and used without impacting operative time. AM create a good separation plane between the dura mater, cerebral cortex, and myocutaneous layer. AM pre and postoperative outcomes are the same as biological substitutes ones. Abstract: Introduction: A dura mater substitute in decompressive craniectomies must protect the brain while providing a dissection plane between the cortex and myocutaneous layer. The human amniotic membrane (AM) has anti-inflammatory, wound healing, and differentiation properties. We tested AM properties as a dural substitute by comparing the outcomes to biological ones. Methods: We prospectively collected data on 25 patients who randomly underwent decompressive craniectomy with lyophilized AM patches and 25 in which biological substitutes were utilized between 2015 and 2019. The AM was laid with the epithelial side facing the brain because of the anti-adhesive proprieties, while the chorion facing the myocutaneous flap. We collected data on demographics, neurological status, comorbidities, and surgical outcomes. Additionally, we created a score – dura mimicking score– and reviewed postoperative imaging and pathological specimens. Results: The majority (96%) of AM grafts were integrated into native dura. Thirteen patients scored as excellent and 11 good on our "dura mimicking score", showing tissue integration ability but no cerebral cortex adhesion. The histopathological analysis showed that AM had thick plates of dense fibrous tissue with small reactive vessels, reactive fibroblasts, and lymphocytes infiltrate. The AM group's first outcomes were not different from the biological substitute patients but higher integration rate to the dura and less adhesion to the myocutaneous flap in AM patients. Conclusions: We documented the anti-adhesive, protective, and integrative properties of AM dural substitute patches in patients who underwent decompressive craniectomies, comparing the intraoperative differences and postoperative outcomes to biological dural substitutes.