A Prospective, Randomized, Controlled Multi-center Study of ArtiFascia® Dural Repair Patch Compared With Commercially Available Dural Substitutes. To Evaluate the Safety and Effectiveness of ArtiFascia® in Subjects Requiring Dural Repair.

A Prospective, randomized, controlled multi-center study of ArtiFascia® Dural repair patch compared with commercially available dural substitutes- NEOART Study.

The dura mater is a fibrous connective tissue that surrounds the nervous system (brain and spinal cord) and provides a mechanical barrier that contains the cerebrospinal fluid (CSF). The dura mater may be damaged as a result of trauma or planned surgery. When dural defects cannot be repaired by primary closure, a dural substitute must be utilized in order to reduce CSF leakage.

There are devices that have been used as dural substitutes. Among the devices that are based on natural raw materials, collagen-based matrices are widely used. Although collagen was proven to be biocompatible, using collagen-based materials still possess several limitations such as CSF leaks. Synthetic dural substitutes are also used to repair dura mater. The most widely used raw-material for these synthetic products are polyesters - resorbable and biocompatible polymers. There are several dural substitutes based on synthetic polyesters that were successfully tested pre-clinically as well as in human studies.

Sponsor of this study has developed the ArtiFascia®. ArtiFascia® is a polymeric synthetic dural substitute that is absorbed by the body.

Before the study, all subjects underwent neurological assessment. Only subjects that were found to be suitable to participate in the study, and agree to participate, were randomly allocated into one of the following groups:

• Experimental group (ArtiFascia® device);
• Control group (Other commercially available suturable dural substitutes).

The Sponsor was blinded to treatment. The subjects underwent the planned surgery and at the end the investigator used ArtiFascia® patch or standard dural substitute to repair the damaged Dura. ArtiFascia® graft was placed in areas where the native dural layer was damaged or missing. ArtiFascia® was applied via a routine and well-known procedure, using a suturing technique. After implantation, the porous fibrous structure of ArtiFascia® provides a scaffold, which enables infiltration of fibroblasts and cells from the intact tissue, ultimately replacing damaged dural tissue. The patch is expected to resorb within a few months and to be replaced by the native tissue with complete dural closure.

During the surgery and until subject's release from the hospital the subject's health was closely monitored. Before the discharge subjects underwent neurological examination. Subjects had been followed up at 4-6 weeks and at 6 months post surgery.

At each follow up visit physical and neurological examinations were performed. Radiographic Evaluation (Magnetic Resonance Imaging) was performed at 6 months post operation.

A total of 92 subjects from 7 sites in Europe were enrolled and implanted with test or control device.

The primary endpoint was achieved when the final study subject has completed a 6-months follow-up.

Inclusion criteria

• Subject between the ages of 18-75
• Subject is scheduled for an elective cranial surgery with a dural damage that can be completely repaired/closed by a suture-able dural substitute (ArtiFascia device or other commercially available dural substitutes)
• Subject has undergone radiographic imaging (such as, MRI) in the past 6 months before enrolment
• Surgical wound is expected to be Class I/clean
• Subject understands the study requirements and the treatment procedures and provides written Informed Consent before any study-specific tests or procedures are performed
• Subject is able and willing to adhere to the required follow-up visits and testing

Exclusion criteria

• Pregnant women or interest in becoming pregnant during the duration of the study
• Subject has known hydrocephalus
• Subject is unable to undergo MRI after the surgery
• Subject's life expectancy is less than 12 months
• Subject has a local or systemic infection (e.g. urinary tract infection (UTI), active pneumonia) or evidence of any surgical site infection, fever > 38.3℃, positive blood culture and/or a positive chest x-ray for acute infectious process
• Subject will require use of dural adhesive or sealant
• Subject is intended to undergo craniectomy wherein bone flap will not be returned
• Subject with suspected low success in wound healing due to past treatments (e.g. chemotherapy, radiation therapy, severe diabetes etc.) or other conditions (e.g. severe peripheral vascular disease, long standing steroids treatment)
• Subject has been clinically diagnosed with malignancy (other than basal cell carcinoma or low-grade glioma), uncontrolled diabetes (A1C>6.5%), sepsis, systemic collagen disease.
• Subject had chemotherapy and/or radiotherapy in the past 12 weeks before surgery or is planned to have chemotherapy or radiotherapy less than 12 weeks after surgery.
• Subject is an acute cranial trauma surgical case
• Subjects with a concurrent disease that would place the patient in excessive risk to the planned surgery
• Subject had a previous neurosurgery in the same anatomical site
• Subject with other undesirable symptoms defined by the principal investigator
• Patient has clinically significant coagulopathy as determined by the surgeon
• Subject is participating in another clinical trial using similar investigational devices/drugs