Estudo comparativo entre pericrânio e pericárdio bovino tratado com polietilenoglicol e etanol como substitutos durais em neurocirurgias supratentoriais

Abstract

Watertight closure of dura mater after intracranial surgery is important to avoid cerebrospinal fluid (CSF) leakage, central nervous system infection and herniation of nervous tissue. When primary closure is not possible, the pericranium is the preferential choice. When it is not available, a dural substitute becomes necessary. Bovine pericardium treated with polyethylene glycol and ethanol, already approved for cardiac surgery, is herein tested as a dural substitute. A clinical-surgical randomized prospective pilot study comparing bovine pericardium with pericranium in supratentorial brain surgery was performed. Patients from both groups were followed for a period of 6 months after surgery. Postoperative incidence of surgical complications, duration of procedures, area of the grafts and epidemiological profile were compared through statistical analysis. From a total of 20 patients initially allocated in the groups, three patients from group 1 and two patients from group 2 had a loss of follow-up, being excluded due to non-related complications and fatal disease progression. In the remaining 15 patients, the epidemiological analysis demonstrated a male:female ratio of 3:4 and 4:4 for groups 1 and 2. Ages varied from 28 to 68 (Mean: 49.6) in group 1 and from 40 to 80 (Mean: 61.2) in group 2, with a mean difference of 11.68 years (p=0.09). No deaths could be associated with the use of dural graft. Two cases of surgical site infection and one case of hydrocephalus were observed. Although the calculated relative risk for complications was higher in group 1 (RR = 1.08), Fisher’s exact test demonstrated no statistically significant difference between groups (p=1.00). Procedure mean time was 23 minutes and 11 seconds in group 1 versus 27 minutes and 55 seconds in group 2 (p=0.47). The mean graft area was 13.17 cm² and 6.23 cm² in groups 1 and 2, respectively (p=0.02). Conclusion: L-Hydro® bovine pericardium treated with polyethylene glycol and ethanol seems to be comparable to pericranium as a dural substitute. More studies are encouraged to certify our findings.