Initial Clinical and Preclinical Testing of an Intraparenchymal Collagen Matrix Tamponade to Prevent CSF Reflux and Promote Regeneration 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 a neuroendoscopic sheath. The outer segment of the graft was unfurled to cover the dural defect. The efficacy of this approach was assessed in two clinical cases using MRI at postoperative days 1, 7, 40, and 60. Parallel in vivo experiments using a juvenile pig model were conducted to evaluate inflammatory response and absorption. In both patients, postoperative MRI demonstrated resolution of subdural fluid collections and progressive absorption of DuraGen® with no complications. 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. 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.