Dural substitutes for spina bifida repair: past, present, and future.
Dural substitutes for spina bifida repair: past, present, and future.
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DOI：
10.1007/s00381-022-05486-8
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发表时间：
2022-05
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影响因子：
--
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中科院分区：
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--
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在脊柱裂(SB)修复过程中，使用材料来促进硬脑膜闭合一直是外科手术中高度研究的一个方面。这篇综述的总体目标是介绍与临床和临床前研究中使用的材料的成功有关的关键发现。此外，这篇综述旨在帮助胎儿外科医生准备开腹或胎儿镜下的产前SB修复。确定了以SB修复过程中使用的硬脑膜替代物为中心的相关出版物。从每篇文章中提取了重要信息，包括发表年份、材料类别和亚类、临床前研究中使用的动物模型、修复是在出生前还是出生后进行的、提供的生物活性物质，以及研究的关键发现。在1121份出版物中，有71份被选中进行全面审查。我们确定了对33个不同地区的调查，其中分别有20种和63种出版物研究了合成材料和天然材料。在这个文库中，43.6%的人关注临床结果，36.6%的人关注临床前结果，19.8%的人关注组织工程方法。总体而言，无论使用何种材料，贴片的使用都显示出成功地保护脊髓，而且大多数都显示出良好的存活率和神经学结果。虽然大多数在临床和临床前研究中都显示出作为一种治疗策略的重要前景，但到目前为止开发的贴片都不被认为是修复SB的完美贴片。因此，有机会开发新的材料和策略，旨在克服这些挑战，进一步改善SB患者的预后。
The use of materials to facilitate dural closure during spina bifida (SB) repair has been a highly studied aspect of the surgical procedure. The overall objective of this review is to present key findings pertaining to the success of the materials used in clinical and pre-clinical studies. Additionally, this review aims to aid fetal surgeons as they prepare for open or fetoscopic prenatal SB repairs. Relevant publications centered on dural substitutes used during SB repair were identified. Important information from each article was extracted including year of publication, material class and sub-class, animal model used in pre-clinical studies, whether the repair was conducted pre-or postnatally, the bioactive agent delivered, and key findings from the study. Out of 1,121 publications, 71 were selected for full review. We identified the investigation of 33 different patches where 20 and 63 publications studied synthetic and natural materials, respectively. From this library, 43.6% focused on clinical results, 36.6% focused on pre-clinical results, and 19.8% focused on tissue engineering approaches. Overall, the use of patches, irrespective of material, have shown to successfully protect the spinal cord and most have shown promising survival and neurological outcomes. While most have shown significant promise as a therapeutic strategy in both clinical and pre-clinical studies, none of the patches developed so far are deemed perfect for SB repair. Therefore, there is an opportunity to develop new materials and strategies that aim to overcome these challenges and further improve the outcomes of SB patients.
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2.2
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