Table 2.
Summarized data of the natural polymeric dural substitutes with their advantages, limitations, study type, no. of subjects, mechanical properties, and anti-CSF leakage properties.
| Type of Dural substitute | Advantages | Limitations | Type of study | No. of subjects | Ultimate tensile strength (MPa) | Young’s modulus (MPa) | CSF leakage | References |
|---|---|---|---|---|---|---|---|---|
| Bacterial cellulose membrane (BCM) | Good porosity, inexpensive and reduces the possibility of secondary epilepsy and epidural scar formation | NA | In vitro and In vivo study (rabbits) | 42 | 9.70 ± 2.56 | 83.64 ± 22.04 | Not observed | Jing et al. 11 |
| GF induced bacterial cellulose membrane (BCM) | No inflammatory reaction seen and promotes the proliferation of cells | NA | In vitro and In vivo study (rats) | NA | 0.96 ± 0.02 | 0.37 ± 0.02 | NA | Stumpf et al. 28 |
| Vancomycin loaded bacterial cellulose membrane (BCM) | Inhibits inflammation, highly elastic and complies with pressure | NA | In vitro and In vivo study (rabbits) | 20 | NA | NA | NA | Xu et al. 29 |
| Bilayer Chitosan scaffold | Thin, inexpensive, promotes collagen fibers formation without any evidence of infection | NA | In vitro and In vivo study (rabbits) | NA | NA | NA | NA | Sandoval-Sánchez et al. 30 |
| Dura-Guard | Robust and can be used in sites with high CSF pressure | NA | In vivo study (hounds) | NA | 13.50 ± 3.34 | 81.33 ± 20.48 | Not observed | Zerris et al. 31 |
| Durepair | Robust and can be used in sites with high CSF pressure | NA | In vivo study (hounds) | NA | 22.70 ± 2.83 | 69.94 ± 9.49 | Not observed | Zerris et al. 31 |
| DuraGen | Effective in repairing dural defects | NA | In vivo study (hounds) | NA | NA | NA | Not observed | Zerris et al. 31 |
| TissuDura | Does not cause inflammatory reactions and does not adhere to surrounding tissue | NA | Clinical study | 208 | NA | NA | Not observed | Esposito et al. 32 |
| TissuDura | No adverse reactions observed | Relatively expensive | Clinical study | 47 | NA | NA | Observed in five patients | Pettorini et al. 33 |
| TissuDura | Demonstrates non-reactivity, elasticity, and good adaptability | NA | Clinical study | 74 | NA | NA | Not observed | Parlato et al. 72 |
| Silk fibroin based substitute | Inhibits inflammation | NA | In vitro and In vivo study (rats) | NA | NA | NA | Not observed | Kim et al. 34 |
| Silk fibroin based substitute | Inhibits CSF leakage and adhesion to surrounding tissue | NA | In vitro study | NA | 1.53 ± 0.45 | 12.1 ± 2.4 | NA | Flanagan et al. 35 |