Histological and biomechanical study of dura mater applied to the technique of dura splitting decompression in Chiari type I malformation.

Many techniques are described to treat Chiari type I malformation. One of them is a splitting of the dura, removing its outer layer only to reduce the risks of cerebrospinal fluid (CSF) leak. We try to show the effectiveness of this technique from histological and biomechanical observations of dura mater. Study was performed on 25 posterior fossa dura mater specimens from fresh human cadavers. Dural composition and architecture was assessed on 47 transversal and sagittal sections. Uniaxial mechanical tests were performed on 22 dural samples (15 entire, 7 split) to focus on the dural macroscopic mechanical behavior comparing entire and split samples and also to understand deformation mechanisms. We finally created a model of volume expansion after splitting. Dura mater was composed of predominant collagen fibers with a few elastin fibers, cranio-caudally orientated. The classical description of two distinct layers remained inconstant. Biomechanical tests showed a significant difference between entire dura, which presents an elastic fragile behavior, with a small domain where deformation is reversible with stress, and split dura, which presents an elasto-plastic behavior with a large domain of permanent strain and a lower stress level. From these experimental results, the model showed a volume increase of approximately 50% below the split area. We demonstrated the capability of the split dura mater to enlarge for suitable stress conditions and we quantified it by biomechanical tests and experimental model. Thus, dural splitting decompression seems to have a real biomechanical substrate to envision the efficacy of this Chiari type I malformation surgical technique.

Mechanical properties of glenoid cancellous bone.

BACKGROUND: Loosening of the glenoid component in total shoulder arthroplasty is the main late complication of this procedure; it may be assumed that it is highly dependent on the quality of the glenoid cancellous bone. Very little is known about the mechanical properties of this cancellous bone. The aim of this study was to determine these properties (Young's modulus and strength) as well as bone density in different parts of the glenoid cancellous bone to assess their variations. METHODS: Eleven scapulas were obtained from six fresh-frozen, unembalmed human cadavers. Eighty-two cubic cancellous bone specimens were extracted and tested using a uniaxial compression test; then the specimens were defatted and correlations with bone density were determined. FINDINGS: The study showed significant differences in the mechanical properties with anatomic location and directions of loading. Young's modulus and strength were found to be significantly higher at the posterior part of the glenoid with the weakest properties at the antero-inferior part. Cancellous bone was found to be anisotropic with higher mechanical properties in the latero-medial direction perpendicular to the articular surface of the glenoid. The apparent density was on average equal to 0.29 g/cm(3) with the higher values at the posterior and superior part of the glenoid. Good correlation between apparent density and elastic modulus was found only in the sagittal planes but not in the coronal and axial plane. INTERPRETATION: The mechanical properties determined in this study showed the anisotropy of the glenoid cancellous bone; values of these properties could provide input data for finite element method analyses in shoulder prosthesis designs.