Clinical experience with freeze-dried cadaveric dura mater has suggested that it is an acceptable dural substitute which does not seem to provoke a significant immune response in the host. A patient is described in whom a cadaveric dural graft provoked an immune reaction leading to meningitis, long after any bacterial contamination or ‘chemical’ reaction would have declared itself. Removal of the graft resulted in full recovery of the patient in parallel with abatement of the immune response as measured in the cerebrospinal fluid. We discuss the experimental basis for claims that this material is not immunogenic and point out that the mechanism for a damaging immune response does exist.

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