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Dura mater repair, commonly used in neurosurgical procedures, uses dural substitutes to repair defects in the dura.
The dura mater (literally, “tough mother”) is the dense, leathery membrane covering and protecting the brain and spinal cord. Dural graft substitutes are used when the opening in the dura is too large to be sutured together.1 There are many ways the dura can become damaged, including severe head injury, tumor ingrowth (meningioma), or a surgeon’s need to open the dura for access to the brain or spinal cord during invasive surgical procedures.
Dural substitutes are necessary to prevent CSF leaks and to allow openings in the dura to heal after surgery. Dural substitutes can be either biological — harvested from animals or human cadavers — or synthetic, and are applied as an onlay or suturable grafts. The main benefit of using a dural substitute lies in its similarity to the patient’s dura and its ability to absorb and integrate itself onto the host tissue.2-5 A dural graft may be preferable to using alternatives from the patient’s body. Using the patient’s pericranium or fascia lata can add additional time and possible complications to a surgery. The pericranium may be too small to cover a large defect in the dura and harvesting fascia lata may cause considerable discomfort to a patient’s leg.6-12 Dural substitutes have the benefit of convenience and are available in large 5-inch x 8-inch sheets (4-inch x 5-inch in CE regulated geographies).
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