ORIGINAL ARTICLE - PEDIATRIC NEUROSURGERY
Homologous cryopreserved amniotic membrane in the repair
of myelomeningocele: preliminary experience
Marina Grazia Mazzucco
Received: 10 April 2018 / Accepted: 23 May 2018
Springer-Verlag GmbH Austria, part of Springer Nature 2018
Objective Surgical management of spinal dysraphism often requires the use of dural substitutes. Amniotic membrane (AM) has
drawn the interest of clinicians for its valuable concentration of cytokines and factors capable of promoting wound healing, re-
epithelialization, inhibiting fibrosis and regulating angiogenesis. These beneficial qualities could make AM an interesting dural
substitute for spina bifida repair. In this study, we describe the use of banked homologous AM as a dural substitute for the repair
of spinal dysraphism in newborns. Our purpose is to test the mechanical characteristics, as well as the safety and effectiveness of
AM in preventing postoperative complications and re-tethering.
Methods The AM patch was carefully detached from the chorion of donors undergoing caesarean section, rinsed in saline
solution, and cryopreserved in liquid nitrogen. Five newborns were treated using AM: three affected by open spinal dysraphism
and two by spina bifida occulta. The AM patch was used as a dural substitute with two different positions and purposes: the
amnion-side down covering the placode to prevent adhesions or placed extradurally facing the dura to avoid scarring and
facilitating the sliding of the dural sac itself under the extradural tissue layers.
Results No adverse events occurred, and the surgical wounds healed without complications. MRI scans taken at 3 and 6 months
after surgery showed a satisfying de-tethering of the spinal cord with no obvious evidence of new adherence formation.
Conclusions We present a multimodal interposition technique using AM as a reconstructive and anti-adhesive tissue for the
treatment of open myelomeningocele (MMC) and lipomeningocele (LMC) treatment. In our experience, AM proved its efficacy
in restoring the dural sac integrity without complications. We support the use of AM as a promising dural substitute, speculating
on how the use of AM could potentially change reconstructive strategies for spinal dysraphism.
Keywords Myelomeningocele repair
Homologous amniotic membrane
Myelomeningocele (MMC) and lypomeningocele (LMC) are
neural tube defects (NTDs) often presenting as a neurosurgical
emergency during the neonatal period. Their incidence has been
declining after the introduction of prophylactic supplementation
of folate in pregnancy, and is now stable at approximately 0.20–
0.40/1000 births/year in western countries [2, 5, 6].
The aim of the surgical management of open MMC and
LMC is to protect the exposed neural structures of the spinal
cord from further neurological damage; it consists in the re-
construction of the dural sac and the superficial muscle and
skin layers overlying the neural placode.
The degree of complexity of the surgical repair depends
mainly on the level and size of the malformation and on the
status of the external tissue layers [2, 4, 8].
Dural reconstruction often entails duroplasty with dural
substitutes in order to fill the defect and to strengthen the thin
and fragile dural layer obtained after microneurosurgical
* Enrico Giordan
Department of Neurosurgery, Treviso Hospital, University of
Padova, Via Piazzale 1, 31100 Padova, Treviso, Italy
Treviso Tissue Bank Foundation, Padova, Italy