Silk-Based Dura Mater Substitutes Featuring Tunable Tissue Integration and Anti-Infective Properties for Neurosurgical Applications.

Dural closure with a replacement is a crucial procedure in neurosurgery. Conventional dura mater substitutes derived from collagen often exhibit low mechanical strength and strong adhesion to the brain tissue, leading to complications such as cerebrospinal fluid leakage, brain adhesion, and intracranial infection. Silk fibroin extracted from silkworms () can be used as an ideal substitute for dura mater with excellent histocompatibility, degradability, and tunable mechanical strength. Herein, a silk-based dura mater substitute is reported, featuring adjustable tissue integration, comparable mechanical strength to the human dura mater (Young's modulus ≈80 MPa), and antibacterial properties. The main part of the silk-based dura mater substitute was modified by using shark skin microstructures to ensure no adhesion to the underlying cortex, and the edge area of the membrane was doped with porous collagen to integrate it with the dura mater. Vancomycin, commonly used in neurosurgery as an effective antibiotic, was preloaded into the silk-based dura mater to achieve a continuous anti-infective effect as the silk membrane degrades and sustainably releases the drug. Overall, this silk-based dura mater substitute is a promising biomaterial for clinical use in neurosurgery.