Healing by secondary intention over NeoDura applicated on a craniectomy defect: a case report and literature review.

Background: NeoDura (Medprin Biotech Gmbh) is an absorbable dural repair patch consisting of degradable poly-L-lactic acid and porcine gelatin that provides a hermetic closure of the dura mater (Medprin Biotech. Neodura. Dural Repair Patch [Brochure]. 2016. https://irp.cdn-website.com/762563d2/files/uploaded/a-NeoDura-Broschüre.pdf . Accessed 24 Sep 2022.). It can be used after resection of a meningioma. If overlying bone and skin structures are absent, an additional flap reconstruction is usually considered, resulting in extensive surgery. However, this study is the first to describe a case of healing by secondary intention over NeoDura as the most superficial layer.

Case presentation: A 48-year-old Caucasian woman had been treated with surgery and whole brain radiotherapy for medulloblastoma in 1976. As radiotherapy-related consequences she developed blindness and multiple secondary tumors (meningioma, basal cell carcinoma). After resection of a large parasagittal meningioma, wound infection and healing problems occurred. The skull flap (10 cm in diameter) had to be removed, and two latissimus dorsi reconstructions failed. As the dura closure using NeoDura appeared watertight, it was decided to attempt healing by secondary intention using vacuum assisted closure, and later, with local wound dressings. This resulted in a complete skin closure after almost 1 year. No local or neurological complications occurred. The tissue was sufficiently resistant to avoid the "syndrome of the trephined," a well-known complication in patients without bony reconstruction after craniectomy.

Conclusion: This is the first description of healing by secondary intention over a craniectomy wound where the normal dura was also removed and replaced by NeoDura. This treatment could be an alternative for extensive reconstructions in patients who are not fit to undergo reconstructive surgery or after failure of reconstruction.