Collagen Dural Graft in Meningocele and Myelomeningocele Repair

In meningocele and myelomeningocele repair, a collagen dural graft is one option when the surgeon decides the dura cannot be closed directly or wants to reinforce the closure. The uses of DECOLL and DURASHEET, pure Type I bovine collagen membranes sized from 2.5 × 2.5 to 10 × 10 cm, include meningocele, myelomeningocele and spinal dural defects after tumour surgery, trauma and lipoma surgery.

Both membranes are on our dural grafts page.

What are meningocele and myelomeningocele?

Both are forms of spinal dysraphism, in which the bony and soft-tissue coverings of the spinal canal do not close completely during development.

• Meningocele: a sac of meninges filled with CSF protrudes through the defect. The spinal cord itself stays in its normal position.
• Myelomeningocele: the sac also contains neural tissue, such as part of the spinal cord or nerve roots. It is an open neural tube defect.

Surgical repair aims to protect the neural tissue, close the dura and rebuild the overlying layers. Myelomeningocele is commonly accompanied by hydrocephalus, which the team assesses and manages separately, sometimes with shunt systems.

Why might a graft be needed in these repairs?

In many repairs the surgeon closes the dura with the patient’s own tissue. A graft comes into consideration when that is not possible or not enough, for example when:

• the available dura is thin, deficient or does not reach across the defect;
• a primary closure would be under tension;
• the surgeon wants an additional layer over a primary repair.

Repair in very young patients has its own considerations, from fragile tissue to CSF dynamics. Our article on dural repair in paediatric neurosurgery covers that background.

Which other spinal dural defects are these grafts used for?

DECOLL and DURASHEET have five uses. Besides meningocele and myelomeningocele, they are:

• Dural defects after spinal tumour surgery, where the dura is opened to reach an intradural lesion or part of it is removed with the tumour attachment.
• Dural defects after trauma, where the injury itself has torn or lost dura.
• Surgical dural defects associated with lipoma, such as those left after surgery for a spinal lipoma linked to the dura or spinal cord.

These situations differ in cause and in patient, but share a practical problem: a spinal dural defect of variable size and shape that has to be closed under the surgeon’s chosen technique. For tumour cases specifically, see our article on dural closure after intradural spinal tumour surgery.

What does a surgeon look for in a graft for these defects?

The questions are similar across all five uses. The table answers them for each DESU membrane.

In both membranes, the impermeable pore structure forms a barrier at the repair site that supports control of CSF leakage. The graft does not by itself guarantee a sealed repair, which depends on the whole closure and the surgeon’s technique.

How do the four sizes relate to spinal defects?

Spinal dural defects range from small openings to long, irregular gaps. Four square sizes, from 2.5 × 2.5 to 10 × 10 cm, let the surgeon choose a graft large enough to cover the defect with the overlap the chosen technique needs, without opening a far larger piece than required.

For the OR team, a practical step is to have more than one size available in the room. The exact extent of a defect is often clear only once it is exposed.

Onlay or sutured: how does technique shape the choice?

Both membranes can be applied as an onlay, laid over the defect so that the graft overlaps the surrounding dura. When the surgeon wants to fix the graft to the dural edges with sutures, DURASHEET is suturable, with high tensile strength. Because it can be used from either surface, it also removes the need to find an upper and lower side during placement.

DECOLL is for onlay application. A surgeon who plans an onlay may choose either product; a surgeon who plans a sutured repair, or wants to keep that option open until the defect is seen, will usually look first at DURASHEET. In every case the decision belongs to the surgeon, guided by the instructions for use.

What should the OR team prepare?

• The product and sizes named on the surgeon’s preference card, plus the next size up.
• The instructions for use, for preparation and placement.
• Implant record documentation: product name and lot number exactly as labelled.
• Any adjuncts the surgeon uses in the layered closure, prepared according to the surgeon’s plan.

Because both products are ready to use without pre-processing, the graft can be opened when the surgeon calls for it rather than prepared in advance.

Talk to a DESU product specialist

If your department treats meningocele, myelomeningocele or other spinal dural defects and you would like documentation or samples of DECOLL and DURASHEET, our product specialists can help. Write to sales@desu.tr, use the contact page, or request a quote.