{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T21:08:43Z","timestamp":1774127323074,"version":"3.50.1"},"reference-count":45,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Integra LifeSciences and the University of Pennsylvania and the Department of Veterans Affairs","award":["IK2-RX003376"],"award-info":[{"award-number":["IK2-RX003376"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>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\u00ae) was used as a parenchymal tract tamponade to seal the tract created by an angiocatheter (preclinical pilot) or neuroendoscopic sheath (clinical case studies). A small pilot study using a juvenile pig model was first conducted to test the implantation technique and to evaluate the inflammatory response to, and absorption of intraparenchymal DuraGen. The efficacy of this approach was then assessed in two clinical cases using MRI at postoperative days 1, 7, 40, and 60. The outer segment of the graft was unfurled to cover the dural defect for clinical application. In the pig model, histological analysis showed healing with minimal inflammation in DuraGen\u00ae-implanted hemispheres, while untreated control tracts exhibited parenchymal scarring and chronic inflammation. In both patients, postoperative MRI demonstrated resolution of subdural fluid collections and progressive absorption of DuraGen\u00ae with no complications. This technique ameliorated CSF leakage and enhanced parenchymal healing after neuroendoscopic surgery. DuraGen\u00ae may modulate the local environment for tissue repair beyond its use in dural grafting.<\/jats:p>","DOI":"10.3390\/ijms26189081","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T12:54:26Z","timestamp":1758200066000},"page":"9081","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Translational Evaluation of an Intraparenchymal Collagen Matrix Tamponade: Initial Preclinical and Clinical Experiments to Prevent CSF Reflux Following Endoscopic Brain Surgery"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4837-6248","authenticated-orcid":false,"given":"Yasuo","family":"Aihara","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tokyo Women\u2019s Medical University, Tokyo 162-8666, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kentaro","family":"Chiba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tokyo Women\u2019s Medical University, Tokyo 162-8666, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuichi","family":"Oda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tokyo Women\u2019s Medical University, Tokyo 162-8666, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5604-3021","authenticated-orcid":false,"given":"Kevin","family":"Browne","sequence":"additional","affiliation":[{"name":"Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"},{"name":"Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dmitriy","family":"Petrov","sequence":"additional","affiliation":[{"name":"Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6076-7065","authenticated-orcid":false,"given":"Takakazu","family":"Kawamata","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tokyo Women\u2019s Medical University, Tokyo 162-8666, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8101-3783","authenticated-orcid":false,"given":"John C.","family":"O\u2019Donnell","sequence":"additional","affiliation":[{"name":"Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"},{"name":"Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.3171\/jns.2000.92.6.1053","article-title":"Transparent sheath for endoscopic surgery and its application in surgical evacuation of spontaneous intracerebral hematomas (technical note)","volume":"92","author":"Nishihara","year":"2000","journal-title":"J. Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1007\/s00381-007-0325-6","article-title":"Endoscopy-guided removal of spontaneous intracerebral hemorrhage: Comparison with CT-guided stereotactic evacuation","volume":"23","author":"Nishihara","year":"2007","journal-title":"Childs Nerv. Syst."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.3171\/JNS-07\/12\/1244","article-title":"New transparent peel-away sheath with neuroendoscopic orientation markers (technical note)","volume":"107","author":"Oi","year":"2007","journal-title":"J. Neurosurg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1097\/00129492-200405000-00030","article-title":"The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery","volume":"25","author":"Selesnick","year":"2004","journal-title":"Otol. Neurotol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1080\/02688697.2021.1903392","article-title":"Preventing cerebrospinal fluid leakage following endoscopy through a burr hole using a novel watertight closure (technical note)","volume":"37","author":"Graupman","year":"2023","journal-title":"Br. J. Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"282","DOI":"10.3340\/jkns.2017.0101.014","article-title":"Prevention of complications in endoscopic third ventriculostomy","volume":"60","author":"Jung","year":"2017","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1308\/rcsann.2020.0006","article-title":"The \u201cmushroom\u201d: A simple and safe technique to avoid cerebrospinal fluid leak after endoscopic third ventriculostomy","volume":"102","author":"Lo","year":"2020","journal-title":"Ann. R Coll. Surg. Engl."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"113","DOI":"10.3171\/ped.2005.102.1.0113","article-title":"Frameless free-hand maneuvering of a small-diameter rigid-rod neuroendoscope with a working channel used during high-resolution imaging (technical note)","volume":"102","author":"Oi","year":"2005","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_9","unstructured":"Integra LifeSciences Corporation (2019, January 01). DuraGen\u00ae Collagen Matrix: Technical Information. Integra LifeSciences. Available online: https:\/\/www.cardion.cz\/file\/90\/duragen-ultrapure-collagen.pdf."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1159\/000330543","article-title":"Postoperative Extra-Axial Cerebrospinal Fluid Collection\u2014Its Pathophysiology and Clinical Management","volume":"47","author":"Eguchi","year":"2011","journal-title":"Pediatr. Neurosurg."},{"key":"ref_11","first-page":"187","article-title":"Complications and pitfalls of neuroendoscopic surgery in children","volume":"105","author":"Peretta","year":"2006","journal-title":"J. Neurosurgery: Pediatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1159\/000120717","article-title":"Endoscopic Ventricular Surgery","volume":"19","author":"Cohen","year":"1993","journal-title":"Pediatr. Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/00006123-199802000-00008","article-title":"Endoscope-assisted brain surgery: Part 2\u2014Analysis of 380 procedures","volume":"42","author":"Fries","year":"1998","journal-title":"Neurosurgery"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"643","DOI":"10.3171\/2011.4.PEDS10503","article-title":"Complications of endoscopic third ventriculostomy","volume":"7","author":"Bouras","year":"2011","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"423","DOI":"10.3171\/2016.4.PEDS163","article-title":"Endoscopic third ventriculostomy in children: Prospective, multicenter results from the Hydrocephalus Clinical Research Network","volume":"18","author":"Kulkarni","year":"2016","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/1477-7819-12-101","article-title":"Surgicel\u2122 application in intracranial hemorrhage surgery contributed to giant-cell granuloma in a patient with hypertension: Case report and review of the literature","volume":"12","author":"Lin","year":"2014","journal-title":"World J. Surg. Oncol."},{"key":"ref_17","first-page":"3996","article-title":"Intracranial foreign body granuloma caused by gelatin sponge: A case report and literature review","volume":"10","author":"Lei","year":"2017","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"203","DOI":"10.2176\/jns-nmc.2021-0355","article-title":"Modified shoelace dural closure with collagen matrix in extended transsphenoidal surgery","volume":"62","author":"Nagata","year":"2022","journal-title":"Neurol. Med. Chir."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2395","DOI":"10.1007\/s00701-021-04856-6","article-title":"Double collagen matrix grafting for dural closure in microvascular decompression: An alternative use of autologous fascial grafting","volume":"163","author":"Inoue","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1007\/s00701-024-05969-4","article-title":"Duraplasty using a combination of a pedicled dural flap and collagen matrix in posterior fossa decompression for pediatric Chiari malformation type 1 with syrinx","volume":"166","author":"Koyama","year":"2024","journal-title":"Acta Neurochir."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"45","DOI":"10.3171\/jns.2007.106.1.45","article-title":"Collagen matrix duraplasty for cranial and spinal surgery: A clinical and imaging study","volume":"106","author":"Narotam","year":"2007","journal-title":"J. Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"380","DOI":"10.3171\/2008.10.JNS08993","article-title":"Collagen matrix duraplasty for posterior fossa surgery: Evaluation of surgical technique in 52 adult patients","volume":"111","author":"Narotam","year":"2009","journal-title":"J. Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1073\/pnas.86.3.933","article-title":"Synthesis and characterization of a model extracellular matrix that induces partial regeneration of adult mammalian skin","volume":"86","author":"Yannas","year":"1989","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"635","DOI":"10.3109\/02688699308995092","article-title":"Experimental evaluation of collagen sponge as a dural graft","volume":"7","author":"Narotam","year":"1993","journal-title":"Br. J. Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"406","DOI":"10.3171\/jns.1995.82.3.0406","article-title":"A clinicopathological study of collagen sponge as a dural graft in neurosurgery","volume":"82","author":"Narotam","year":"1995","journal-title":"J. Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1227\/00006123-199002000-00004","article-title":"Neurosurgical applications of fibrin glue: Augmentation of dural closure in 134 pa-tients","volume":"26","author":"Shaffrey","year":"1990","journal-title":"Neurosurgery"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"215","DOI":"10.3171\/JNS\/2008\/109\/8\/0215","article-title":"Efficacy and safety of a collagen matrix for cranial and spinal dural reconstruction using different fixation techniques","volume":"109","author":"Stendel","year":"2008","journal-title":"J. Neurosurg."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Tamura, R., Kuranari, Y., Orikasa, H., and Katayama, M. (2022). Meningioma Cell Invasion into DuraGen-Derived Dura Mater: A Case Report. Medicines, 9.","DOI":"10.3390\/medicines9040030"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"16","DOI":"10.3171\/ped.2006.104.1.16","article-title":"Experience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations","volume":"104","author":"Danish","year":"2006","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.1007\/s00701-011-1059-5","article-title":"Evaluation of efficacy and biocompatibility of a novel semisynthetic collagen matrix as a dural onlay graft in a large animal model","volume":"153","author":"Neulen","year":"2011","journal-title":"Acta Neurochir."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"877","DOI":"10.4049\/jimmunol.136.3.877","article-title":"The human immune response to reconstituted bovine collagen","volume":"136","author":"Ellingsworth","year":"1986","journal-title":"J. Immunol."},{"key":"ref_32","first-page":"198","article-title":"An experimental study on the prevention of postlaminectomy scar formation: Efficacy of interpositional collagen-sponge","volume":"69","author":"Jinnin","year":"1995","journal-title":"Nippon Seikeigeka Gakkai Zasshi"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"133","DOI":"10.5152\/eurasianjmed.2018.17422","article-title":"Histopathological investigation of the effectiveness of collagen matrix in the repair of experimental spinal dura mater defects","volume":"51","author":"Calikoglu","year":"2019","journal-title":"Eurasian J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2861","DOI":"10.1097\/01.brs.0000148049.69541.ad","article-title":"Collagen matrix (DuraGen) in dural repair: Analysis of a new modified technique","volume":"29","author":"Narotam","year":"2004","journal-title":"Spine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"50","DOI":"10.3171\/spi.2005.2.1.0050","article-title":"Postoperative fibrosis after surgical treatment of the porcine spinal cord: A comparison of dural substitutes","volume":"2","author":"Haq","year":"2005","journal-title":"J. Neurosurg. Spine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"361","DOI":"10.5414\/NPP27361","article-title":"Histological analysis of DuraGen in a human subject: Case report","volume":"27","author":"Khorasani","year":"2008","journal-title":"Clin. Neuropathol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1016\/j.clineuro.2013.03.013","article-title":"Collagen-only biomatrix as dural substitute: Results at 5-year follow-up","volume":"115","author":"Esposito","year":"2013","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"714","DOI":"10.3171\/2010.7.JNS10460","article-title":"Non-watertight dural reconstruction in meningioma surgery: Results in 439 consecutive patients and a review of the literature","volume":"114","author":"Sade","year":"2011","journal-title":"J. Neurosurg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1002\/jbm.b.30831","article-title":"Repair of the dura mater with processed collagen devices","volume":"83","author":"Zerris","year":"2007","journal-title":"J. Biomed. Mater. Res. Part B Appl. Biomater."},{"key":"ref_40","first-page":"188","article-title":"The comparison of histopathological results of repairing dural defects in rats using different collagen-based grafts","volume":"13","author":"Aksekili","year":"2017","journal-title":"Electron. J. Biol."},{"key":"ref_41","unstructured":"Mooradian, D.L. (2016). Extracellular matrix-derived tissues for neurological applications. Extracellular Matrix\u2013Derived Implants in Clinical Medicine, Woodhead Publishing."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1179\/016164105X49364","article-title":"Growth of rat cortical neurons on DuraGen, a collagen-based dural graft matrix","volume":"27","author":"Rabinowitz","year":"2005","journal-title":"Neurol. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.jconrel.2020.02.028","article-title":"Safe nanoengineering and incorporation of transplant populations in a neurosurgical grade biomaterial, DuraGen PlusTM, for protected cell therapy applications","volume":"321","author":"Finch","year":"2020","journal-title":"J. Control. Release"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s10143-025-03185-x","article-title":"Artificial dural regeneration matrix as a substitute for autologous tissue in indirect bypass in Moyamoya disease: Investigation of a rat model of chronic cerebral hypoperfusion","volume":"48","author":"Kameno","year":"2025","journal-title":"Neurosurg. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Maeda, T., Suzuki, K., Nisson, P.L., Mochizuki, Y., Mizuno, R., Teranishi, A., Take, Y., Kayahara, T., and Kurita, H. (2025). Histopathological analysis of Duragen collagen matrix over time in humans. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-95489-7"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/18\/9081\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:47:39Z","timestamp":1760035659000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/18\/9081"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":45,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["ijms26189081"],"URL":"https:\/\/doi.org\/10.3390\/ijms26189081","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,18]]}}}