Super-hydrophilic and super-lubricating Zwitterionic hydrogel coatings coupled with polyurethane to reduce postoperative dura mater adhesions and infections

The dura trauma or large defects due to neurosurgical procedures can result in potential complications. Dural replacements have proven effective to reduce the risk of seizures, meningitis, cerebrospinal fluid leakage, cerebral herniation, and infection. Although various artificial dural patches have been developed, addressing iatrogenic infections and cerebral adhesions resulting from patches implantation remains a challenge. This study employed a network interpenetration modification strategy to introduce super-hydrophilic and super-lubricity zwitterionic hydrogel coatings on polyurethane Neuro-Patch® (NP®) dura mater patch. The successful modification with the hydrogel coating preserved the intrinsic properties of the NP®, such as their anti-leakage and tensile strength capabilities, while effectively reducing biofouling on the surface of the patches. Additionally, by constructing subdural implantation for each dura mater substitute in rabbits, we observed that artificial dura mater patches modified with the hydrogel coating effectively reduced the incidence of postoperative cerebral adhesions and infections. This suggests a promising application prospect of the hydrogel coating in dural repair. STATEMENT OF SIGNIFICANCE: The development of dural substitutes with anti-leakage, anti-adhesion and anti-infection functions is the key to the treatment of dural defects and cerebrospinal fluid leakage during trauma or neurosurgery. In this study, the amphoteric ionic hydrogel coating was firmly modified on the surface of polyurethane with a mild modification process to give the patch super-hydrophilic and super-lubricating properties. The adhesion of non-specific proteins and bacteria is effectively reduced. The rabbit dural defect repair model showed that the introduction of zwitterionic hydrogel coating effectively reduced the occurrence of postoperative infection, and no tissue adhesion was observed. Taken together, this study offers a promising way to enhance the performance of artificial dural patches, potentially benefiting patients undergoing neurosurgery.