Dura mater repair represents a final and crucial step in cranial surgery: an inadequate dural reconstruction determines dreadful consequences that significantly increase morbidity and mortality rates. Different dural substitutes have been used with poor results. To overcome this issue, in previous studies we proposed a laser-based approach to the bonding of porcine dura mater, evidencing the feasibility of the laser assisted procedure. In this work, we present the optimization of the laser bonding approach ex vivo in porcine dura mater and in vivo in rats. An 810 nm cw laser was used to weld the ICG stained chitosan patch to the dura. The ex vivo tests enabled to optimize the laser parameters, using histology and leak pressure evaluation to study the bonding effect. The in vivo tests were performed on 32 adult Wistar rats: laser bonding was carried out in 16 rats, while a collagen matrix was used for duroplasty in the control group. After the treatment, the animals were left to recover and were observed in a 15 and 90 days follow up study. At sacrifice, the rats were anesthetized for fluid leakage pressure test; treated tissue was harvested and underwent standard histology. The results of this study pointed out that the laser bonding procedure can be used to close the dura mater, both ex vivo and in vivo. The thermal effect is limited and spatially confined. The technique can thus be proposed as a valid alternative to standard method for the closuring of dura mater in cranial surgery.
Laser bonding is a promising minimally invasive approach, emerging as a valid alternative to conventional suturing techniques. It shows widely demonstrated advantages in wound treatment: immediate closuring effect, minimal inflammatory response and scar formation, reduced healing time. This laser based technique can overcome the difficulties in working through narrow surgical corridors (e.g. the modern “key-hole” surgery as well as the endoscopy setting) or in thin tissues that are impossible to treat with staples and/or stitches. We recently proposed the use of chitosan matrices, stained with conventional chromophores, to be used in laser bonding of vascular tissue. In this work we propose the same procedure to perform laser bonding of vocal folds and dura mater repair. Laser bonding of vocal folds is proposed to avoid the development of adhesions (synechiae), after conventional or CO2 laser surgery. Laser bonding application in neurosurgery is proposed for the treatment of dural defects being the Cerebro Spinal Fluid leaks still a major issue.
Vocal folds and dura mater were harvested from 9-months old porks and used in the experimental sessions within 4 hours after sacrifice.
In vocal folds treatment, an IdocyanineGreen-infused chitosan patch was applied onto the anterior commissure, while the dura mater was previously incised and then bonded. A diode laser emitting at 810 nm, equipped with a 600 μm diameter optical fiber was used to weld the patch onto the tissue, by delivering single laser spots to induce local patch/tissue adhesion. The result is an immediate adhesion of the patch to the tissue. Standard histology was performed, in order to study the induced photothermal effect at the bonding sites. This preliminary experimental activity shows the advantages of the proposed technique in respect to standard surgery: simplification of the procedure; decreased foreign-body reaction; reduced inflammatory response; reduced operating times and better handling in depth.
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