Translational Evaluation of an Intraparenchymal Collagen Matrix Tamponade: Initial Preclinical and Clinical Experiments to Prevent CSF Reflux Following Endoscopic Brain Surgery

Transparent polymer sheaths are often utilized in neuroendoscopic procedures to minimize intraventricular bleeding and parenchymal injuries. However, cerebrospinal fluid (CSF) leakage remains a common complication following neuroendoscopic surgery for intraventricular and deep-seated lesions. We investigated an innovative technique to prevent postoperative CSF leakage through the tract using a collagen matrix dural graft. A rolled collagen matrix (DuraGen®) was used as a parenchymal tract tamponade to seal the tract created by an angiocatheter (preclinical pilot) or neuroendoscopic sheath (clinical case studies). A small pilot study using a juvenile pig model was first conducted to test the implantation technique and to evaluate the inflammatory response to, and absorption of intraparenchymal DuraGen. The efficacy of this approach was then assessed in two clinical cases using MRI at postoperative days 1, 7, 40, and 60. The outer segment of the graft was unfurled to cover the dural defect for clinical application. In the pig model, histological analysis showed healing with minimal inflammation in DuraGen®-implanted hemispheres, while untreated control tracts exhibited parenchymal scarring and chronic inflammation. In both patients, postoperative MRI demonstrated resolution of subdural fluid collections and progressive absorption of DuraGen® with no complications. This technique ameliorated CSF leakage and enhanced parenchymal healing after neuroendoscopic surgery. DuraGen® may modulate the local environment for tissue repair beyond its use in dural grafting.