Table 1.

Patches utilized for spina bifida repair in a clinical setting.

Material class	Material subclass	Patch component	Trade name	Repair	Key findings	Reference
Synthetic	Silica	Silicone coated polyester fabric	Dacron	Postnatal	Case report indicating satisfactory repair of a 1-day-old female with MMC using a patch of silicone coated Dacron	[6]
				Postnatal	Dacron used to repair lipomeningocele provided an adequate barrier, but led to complications	[7]
		Medical adhesive silicone	Silastic	Postnatal	The use of Silastic to repair MMC demonstrated 5 years with no tethered cord, but there was an increased risk of CSF leakage	[8]
				Postnatal	Dacron-reinforced silastic led to increased fibroblastic response compared to nonreinforced Silastic patches	[9]
	Polytretrafluoroethylene (PTFE)	Teflon	Gore-Tex, Gore	Postnatal	PTFE can prevent adhesion of the spinal cord with no significant complications	[10]
			Preclude	Postnatal	Case study demonstrated successful management of 29-week infant born with an MMC treated with Gore-Tex patch	[11]
				Prenatal	Developed a percutaneous fetoscopic method for prenatal patch coverage that achieved tight patch attachment	[12]
				Postnatal	No difference in incidence of CSF leakage in patients that received primary dural closure, PTFE patch, or bovine pericardium patch and patches inhibited retethering compared to primary dural closure	[13]
				Prenatal	Fetoscopic surgical implantation of extracellular matrix or PTFE patches led to 13% patient complication and all operated fetuses required postnatal re-coverage	[14]
				Prenatal	12-month follow-up of 71 patients who were repaired prenatally with teflon or collagen patches: 28% required recoverage and 45% required shunt placement	[15]
	Polyesterurethane	Polyesterurethane	Neuro-Patch	Postnatal	A Neuro-Patch was used under a Limberg Flap when primary dura closure was not possible	[16]
Natural	Porcine	Small intestine submucosa-derived extracellular matrix	Durasis	Prenatal	Fetuses fetoscopically repaired with Durasis patch showed reversal of hindbrain herniation, near-normal leg function, and satisfactory bladder and bowel function	[17]
				Prenatal	Fetoscopic surgical implantation of extracellular matrix or PTFE patches led to 13% patient complication and all operated fetuses required postnatal re-coverage	[14]*
				Prenatal	12-month follow-up of 71 patients who were repaired prenatally with Goretex or Durasis patches: 28% required recoverage and 45% required shunt placement	[15]*
	Equine	Achilles tendon derived collagen foil	TissuDura	Postnatal	The use of TissuDura as a dural substitute did not lead to hydrocephalus, scar adhesion, or a foreign body reaction	[18]
	Bovine	Tendon	Duragen	Postnatal	Case study demonstrated that a combination of collagen and dermal matrix dural substitutes lead to sufficient coverage after several failed attempts of closure	[19]*
				Prenatal and postnatal	Prenatal surgery for myelomeningocele has better outcomes over postnatal	[4]
			Duraform	Prenatal	Duraform was used as a dural substitute when the dura could not reach over the entire defect	[20]
		Dermis	Durepair	Prenatal	Three-layer closure led to lower incidence of cerebral spinal fluid leakage and increased rate of reversal of hindbrain herniation compared to single-layer closure	[21]
				Postnatal	Case study demonstrated that acellular dermal matrix is a feasible option for primary coverage of MMC	[22]
		Pericardium	Dura-Guard	Postnatal	No difference in incidence of CSF leakage in patients that received primary dural closure, PTFE patch, or bovine pericardium patch and patches inhibited retethering compared to primary dural closure	[13]*
	Human	Cryopreserved amniotic membrane		Postnatal	No neurological or late complications were reported and coverage was still intact 19 months after repair	[23]
				Postnatal	Amniotic membrane repair did not lead to spinal cord tethering 6 months after surgery	[24]
		Dermal Matrix	Alloderm	Postnatal	Case study demonstrated that a combination of collagen and dermal matrix dural substitutes leads to sufficient coverage after several failed attempts of closure	[19]*
				Prenatal	Case study demonstrated that MMC repair with Alloderm resulted in the presence of a dermoid cyst and severe tethering	[25]
				Prenatal	Fetoscopic repair, although feasible, does not yet yield optimal surgical results	[26]
		Maternal Skin Graft		Prenatal	Survivors of fetoscopic repair using maternal skin graft possessed only mild locomotor deficits	[27]
				Prenatal	In utero repair through a hysterotomy may be technically superior compared to an endoscopy technique	[28]
		Autologous Amniotic Membrane		Postnatal	Case study demonstrated that three-layer autologous amnion led to a watertight closure	[29]
		Cadaver Dura	Tutoplast	Postnatal	Graft of freeze-dried cadaver was successfully used as a dural substitute	[30]
	Plant	Biocellulose nanofiber mesh	Bionext	Prenatal	Fetoscopic biocellulose patch MMC repair leads to reversed hindbrain herniation and favorable neurological and motor function outcomes	[31]
				Prenatal	Fetoscopic MMC repair with biocellulose patch led to a successful surgical closure	[32]
				Prenatal	Fetoscopic MMC repair with biocellulose led to reversal of hindbrain herniation and normal motor function	[33]
				Prenatal	Large open spina bifida defects were successfully treated with a bilaminar skin substitute over a biocellulose patch through percutaneous approach	[34]
		Sodium hyaluronate/carboxymethylcellulose	Seprafilm	Prenatal	Case study demonstrated that at 7 months of age, the child possessed no obvious neurological deficit, normal leg movement, and bladder function	[35]

^*Indicates publications that studied multiple patches