ABSTRACT
Objective
The aim of this experimental study was to investigate the effects of autologous plasma
used as an alternative to duraplasty
Materials and Methods
We operated 21 patients and 8 New Zealand Rabbits and performed duraplasty with
autologous blood. First heparin was added to autologous blood withdrawn from the patient/
rabbit, The sample was then centrifuged to obtain plasma. protamine sulfate was added
to the plasma This mixture was then applied to the dural space and tumor cavity, resulting
in fibrin formation within 2-3 minutes. All 21 patient had MRI scans 1 month after
surgery to show neodura formation. 3 of our patients and all rabbit subjects were
operated at least a month later and the biopsie was taken to show the neodura formation
microsopically.
Results
In MRI scans, as well as in biopsies, we have detected the neodura formation. In rabbits
that underwent experimental craniotomy and duratomy, neodura had formed as a weak,
thin membrane that did not show continuity into the defect area after one month. In
the control group, the distribution of collagen fibers appeared relatively normal
in areas close to the intact dura. However, further from this area, the regular structure
was disrupted, edematous areas had formed in the fibrous layers, and bone fragments
were separated from the endosteal layer
Conclusion
The hypothesis of this study was that plasma obtained from the patient’s own arterial
blood could serve as an alternative to traditional duraplasty materials. Plasma possesses
many of the properties required for duraplasty material and can be a cost-effective,
readily available option.
Results demonstrate that autologous plasma does not induce significant histological
changes and shows excellent biocompatibility with brain parenchyma. Therefore, autologous
plasma can be considered a reliable and safe tissue sealant. It is easy to prepare
and apply, remains stable in the operating room for 1-2 hours, and can be adjusted
in size and thickness according to the dural defect and tumor cavity dimensions.
SUMMARY
Duraplasty is performed in the following cases:
a.) When there are duramater tears of traumatic, spontaneous, or iatrogenic origin,
or when associated with tumor invasion.
b.) When primary suturing cannot be performed on the thinned duramater due to increased
intracranial pressure, edema, contusion, or swelling.
c.) When a drain is required for oozing bleeding of the parenchyma.
d.) When compressive duratomy, craniotomy, or lobectomy has been performed.
e.) In cases with pseudoencephalocele.
f.) When constructive adaptation of the dura is required, such as in Chiari malformation.
Since the 1800s, numerous allogeneic (homologous), xenogenic (heterologous), autologous,
and biosynthetic graft materials have been used in duraplasty. However, none of these
materials have proven to be superior to others. Therefore, the aim of this study was
to use plasma obtained from the arterial blood of each subject as an alternative for
duraplasty to fill dura defects and tumor cavities.
Key words: Duraplasty, plasma, neodura, CSF leakageCraniectomy and duratomy were performed,
followed by duraplasty using autologous arterial plasma. Brain and neodura biopsies
were taken after one month. No significant complications developed. Magnetic resonance
imaging was performed one month later to check for the formation of neodura. The results
of light and electron microscopy examinations demonstrated that arterial plasma could
be an alternative to traditional duraplasty methods.
