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Yeh KL, Wu SH, Fuh CS, Huang YH, Chen CS, Wu SS. Cauda equina syndrome caused by the application of DuraSeal TM in a microlaminectomy surgery: A case report. World J Clin Cases 2022; 10:11178-11184. [PMID: 36338214 PMCID: PMC9631147 DOI: 10.12998/wjcc.v10.i30.11178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The management of dural tears is important. While a massive dura can be repaired with absorbable suture lines, cerebrospinal fluid leakage can be attenuated by dural sealant when an unintended tiny durotomy occurs intraoperatively. DuraSeal is often used because it can expand to seal tears. This case emphasizes the need for caution when DuraSeal is used as high expansion can cause complications following microlaminectomy.
CASE SUMMARY A 77-year-old woman presented with L2/3 and L3/4 lateral recess stenosis. She underwent microlaminectomy, foraminal decompression, and disk height restoration using an IntraSPINE® device. A tiny incident durotomy occurred intraoperatively and was sealed using DuraSealTM. However, decreased muscle power, urinary incontinence, and absence of anal reflexes were observed postoperatively. Emergent magnetic resonance imaging revealed fluid collection causing thecal sac indentation and central canal compression. Surgical exploration revealed that the gel-like DuraSeal had entrapped the hematoma and, consequently, compressed the thecal sac and nerve roots. While we removed all DuraSealTM and exposed the nerve root, the patient’s neurological function did not recover postoperatively.
CONCLUSION DuraSeal expansion must not be underestimated. Changes in neurological status require investigation for cauda equina syndrome due to expansion.
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Affiliation(s)
- Kuei-Lin Yeh
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan
- Department of Long-Term Care and Management, WuFeng University, Chiayi County 621303, Taiwan
| | - Szu-Hsien Wu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Chiou-Shann Fuh
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Yi-Hung Huang
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan
| | - Chu-Song Chen
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Shing-Sheng Wu
- Department of Orthopaedics, Shin Kong Wu-Ho Su Memorial Hospital, Taiepi 111, Taiwan
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Kinaci A, Bergmann W, van Thoor S, Redegeld S, van der Zwan A, van Doormaal TPC. Safety and biodegradability of a synthetic dural sealant patch (Liqoseal) in a porcine cranial model. Animal Model Exp Med 2021; 4:398-405. [PMID: 34977491 PMCID: PMC8690992 DOI: 10.1002/ame2.12184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/09/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Liqoseal consists of a watertight layer of poly(ester)ether urethane and an adhesive layer containing polyethylene glycol-N-hydroxysuccinimide (PEG-NHS). It is designed to prevent cerebrospinal fluid (CSF) leakage after intradural surgery. This study assessed the safety and biodegradability of Liqoseal in a porcine craniotomy model. Methods In 32 pigs a craniotomy plus durotomy was performed. In 15 pigs Liqoseal was implanted, in 11 control pigs no sealant was implanted and in 6 control pigs a control dural sealant (Duraseal or Tachosil) was implanted. The safety of Liqoseal was evaluated by clinical, MRI and histological assessment. The degradation of Liqoseal was histologically estimated. Results Liqoseal, 2 mm thick before application, did not swell and significantly was at maximum mean thickness of 2.14 (±0.37) mm at one month. The foreign body reaction induced by Liqoseal, Duraseal and Tachosil were comparable. Liqoseal showed no adherence to the arachnoid layer and was completely resorbed between 6 and 12 months postoperatively. In one animal with Liqoseal, an epidural fluid collection containing CSF could not be excluded. Conclusion Liqoseal seems to be safe for intracranial use and is biodegradable. The safety and performance in humans needs to be further assessed in clinical trials.
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Affiliation(s)
- Ahmet Kinaci
- Department of Neurology and Neurosurgery, Brain CenterUniversity Medical Centre UtrechtUtrechtThe Netherlands
- Brain Technology InstituteUtrechtThe Netherlands
| | - Wilhelmina Bergmann
- Division of PathologyFaculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | | | | | - Albert van der Zwan
- Department of Neurology and Neurosurgery, Brain CenterUniversity Medical Centre UtrechtUtrechtThe Netherlands
- Brain Technology InstituteUtrechtThe Netherlands
| | - Tristan P. C. van Doormaal
- Department of Neurology and Neurosurgery, Brain CenterUniversity Medical Centre UtrechtUtrechtThe Netherlands
- Brain Technology InstituteUtrechtThe Netherlands
- Department of NeurosurgeryClinical Neuroscience CenterUniversity Hospital ZurichZurichSwitzerland
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Han HJ, Jeong JH, Kim JW, Seung WB. Postoperative Thecal Sac Compression Induced by Hydrogel Dural Sealant after Spinal Schwannoma Removal. Korean J Neurotrauma 2020; 16:99-104. [PMID: 32395458 PMCID: PMC7192801 DOI: 10.13004/kjnt.2020.16.e10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/23/2020] [Accepted: 04/07/2020] [Indexed: 11/15/2022] Open
Abstract
Cerebrospinal fluid (CSF) leak is a common complication of spinal and cranial surgery, and patients undergoing spinal tumor surgery are probably particularly predisposed due to the presence of an intradural tumor and many other factors. Furthermore, a meticulous dural closure technique does not always result in watertight closure. A number of adjunctive methods have been used to assist with dural closure. Synthetic, absorbable polyethylene glycol hydrogel dural sealants are widely used and have been approved for use as adjuncts for cranial applications requiring sutured dural closure. We report a case of thecal sac compression by DuraSeal® Dural Sealant used to repair the CSF leak after intentional durotomy during lumbar schwannoma extirpation.
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Affiliation(s)
- Hong Joon Han
- Department of Neurosurgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Ju Ho Jeong
- Department of Neurosurgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Won Bae Seung
- Department of Neurosurgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
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Soneru CP, Riley CA, Minkowitz S, Tabaee A, Anand VK, Schwartz TH. Adherus Dural Sealant in Endoscopic Skull Base Surgery: Safety, Imaging Characteristics, and Sinonasal Quality of Life. J Neurol Surg B Skull Base 2019; 81:659-663. [PMID: 33381370 DOI: 10.1055/s-0039-1694048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022] Open
Abstract
Objective This study was aimed to compare the safety profiles, magnetic resonance imaging (MRI) findings, and sinonasal outcome test (SNOT-22) scores of Adherus dural sealant, a novel tissue glue designed for skull base surgery. Design Present study is a prospective case series. Setting The research work took place at a tertiary-care academic medical center. Participants Consecutive series of 26 patients undergoing endoscopic skull base surgery (ESBS) with Adherus was compared with a control group of 24 patients matched for tumor type and size with DuraSeal as a sealant. Main Outcome Measures Postoperative complication rates, imaging characteristics, and postoperative SNOT-22 scores were measured and compared. Results No postoperative cerebrospinal fluid (CSF) leaks, intracranial hemorrhages, or mucoceles were observed in either cohort. Adherus was more likely to be identifiable on immediate postoperative MRI (50 vs. 20.8%, p = 0.032). In patients in whom a nasoseptal flap was utilized, the flap was opposed to the skull base in all cases regardless of sealant selected. Postoperative SNOT-22 total (17.25 [±10.81] vs. 14.85 [±14.22], p = 0.609) and subdomain scores were similar between the two groups. Conclusions Adherus dural sealant appears to be a safe alternative to Duraseal in ESBS with comparable quality of life outcomes and imaging findings. These preliminary results are promising but should be examined in a larger population with long-term follow-up.
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Affiliation(s)
- Christian P Soneru
- Departments of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
| | - Charles A Riley
- Departments of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
| | - Shlomo Minkowitz
- Departments of Radiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
| | - Abtin Tabaee
- Departments of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
| | - Vijay K Anand
- Departments of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
| | - Theodore H Schwartz
- Departments of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
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Lewis PB, Wilson ST, Kentala DR, Barry J, Lewis KM. Computed Tomographic Characterization of Traumastem-A New Oxidized Cellulose Hemostatic Agent. ACTA ACUST UNITED AC 2016; 2:175-178. [PMID: 30042962 PMCID: PMC6024394 DOI: 10.18383/j.tom.2016.00238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Oxidized regenerated cellulose (ORC) is a commonly used surgical hemostatic agent. When retained at the surgical site, it is frequently misdiagnosed on postoperative computed tomography (CT) images as an abscess or a recurrent tumor. Oxidized nonregenerated cellulose (ONC) is a new, more effective version of ORC. It is more effective because of its unorganized fiber structure and greater material density, which may also alter its appearance on CT images relative to ORC. This image report compares the CT characteristics of ONC and ORC. A rabbit's bilateral femoral arteries were punctured to model peripheral vascular surgery. ORC was used to treat 1 of the femoral artery punctures and ONC to treat the contralateral puncture. Noncontrast CT imaging was performed immediately following surgery (day 0) and on postoperative day 14. On day 0, both ORC and ONC were isoattenuating relative to muscle and hyperattenuating to fat, although ONC appears more homogenous. On day 14, neither ORC nor ONC was clearly identifiable. Thus, postoperative retention of ONC can obscure immediate postoperative CT interpretation and, similar to ORC, lead to an erroneous diagnosis of an abscess. By day 14, ONC retention may not obscure CT interpretation. In noncontrast CT imaging, ONC appears more homogeneous than ORC, but is otherwise indistinguishable. The greater homogeneity of ONC may be caused by the unorganized fiber structure or greater material density. Intraoperative use of ONC should be clinically investigated before radiographically diagnosing a postoperative abscess or recurrent tumor.
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Affiliation(s)
- Paul B Lewis
- Department of Radiology, Mercy Rockford Health System, Rockford, Illinois
| | | | | | - John Barry
- Baxter Healthcare Corporation, Deerfield, Illinois
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Siman H, Techy F. Transcutaneous Drainage of Gel-Like Substance after Application of Hydrogel Dural Sealant: Report of Two Cases. Global Spine J 2016; 6:e7-e10. [PMID: 26835216 PMCID: PMC4733387 DOI: 10.1055/s-0035-1550088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 02/17/2015] [Indexed: 12/05/2022] Open
Abstract
Study Design Case report. Objective Incidental durotomy (IDT) is a common complication of spinal surgery. The use of collagen matrix graft along with hydrogel dural sealant is a common method of IDT repair. With this method, there have been several reported cases of detrimental dural sealant expansion in the literature. One case study reported an expansion rate greater than 300%; many report neurologic damage. This article reports the clinical course of two patients who developed postoperative transcutaneous drainage of a gel-like substance after the use of a dural sealant, which is a previously unreported complication. Methods The clinical course and treatment outcome of two patients is presented. Results Both patients experienced postoperative transcutaneous drainage of a gel-like substance at the surgical site. Case one began draining this substance on postoperative day 14. This patient required no further intervention, and the drainage ended after 3 mL of a gel-like substance was expressed from his incision while in the clinic. Case two began draining the gel on postoperative day 16. This patient underwent two washout procedures and resolution of the drainage. No infection was ever detected. Conclusions To our knowledge, our patients are the first reported cases of transcutaneous drainage of expanded dural sealant. It is important to take into consideration the unexpected expansion of a dural sealant when using it for the repair of IDT.
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Affiliation(s)
- Homayoun Siman
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois
| | - Fernando Techy
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois,Address for correspondence Fernando Techy, MD Department of Orthopaedic Surgery, University of Illinois835 S. Wolcott AvenueChicago, IL 60612
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JITO J, NITTA N, NOZAKI K. Delayed Cerebrospinal Fluid Leak after Watertight Dural Closure with a Polyethylene Glycol Hydrogel Dural Sealant in Posterior Fossa Surgery: Case Report. Neurol Med Chir (Tokyo) 2014; 54:634-9. [DOI: 10.2176/nmc.cr2013-0010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Junya JITO
- Department of Neurosurgery, Shiga University of Medical Science
| | - Naoki NITTA
- Department of Neurosurgery, Shiga University of Medical Science
| | - Kazuhiko NOZAKI
- Department of Neurosurgery, Shiga University of Medical Science
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Lee SH, Park CW, Lee SG, Kim WK. Postoperative Cervical Cord Compression Induced by Hydrogel Dural Sealant (DuraSeal®). KOREAN JOURNAL OF SPINE 2013; 10:44-6. [PMID: 24757459 PMCID: PMC3941731 DOI: 10.14245/kjs.2013.10.1.44] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/03/2013] [Accepted: 03/14/2013] [Indexed: 11/19/2022]
Abstract
Cerebrospinal fluid (CSF) leakage is a potential complication of cranial and spinal surgery. Postoperative CSF leakage can induce delayed healing, wound infection and meningitis. DuraSeal® (Covidien, Waltham, MA, USA) is a synthetic product which has been increasingly used to facilitate watertight repair of dural defects after cranial and spinal surgery. Despite some advantages of Duraseal®, the authors report a patient who developed cord compression following the use of DuraSeal® in cervical spine surgery in which the expansion of the DuraSeal® was believed to be the causative factor.
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Affiliation(s)
- Si-Hoon Lee
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Chan-Woo Park
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Sang-Gu Lee
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Woo-Kyung Kim
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
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Neuman BJ, Radcliff K, Rihn J. Cauda equina syndrome after a TLIF resulting from postoperative expansion of a hydrogel dural sealant. Clin Orthop Relat Res 2012; 470:1640-5. [PMID: 21952743 PMCID: PMC3348307 DOI: 10.1007/s11999-011-2071-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND DuraSeal(™) (Coviden, Waltham, MA, USA), a hydrogel sealant, is primarily used as an adjunct to a dural repair. Its use has also been described to seal off an annulotomy after a transforaminal lumbar interbody fusion when recombinant human bone morphogenetic protein-2 (rhBMP-2) is used. This aids in the reduction of postoperative radiculitis caused by rhBMP-2. However, as a result of its hydrophilic properties, DuraSeal(™) has the potential to swell, which could lead to compression of the thecal sac. CASE DESCRIPTION We report a 57-year-old woman who developed cauda equina after a transforaminal lumbar 47 interbody fusion (TLIF) procedure in which the expansion of the DuraSeal(™) was believed to be the causative factor. The patient developed urinary retention, bowel incontinence, and paresthesias in the saddle region on postoperative Day 3. She underwent emergent exploration and decompression of the thecal sac. The gel-like DuraSeal™ material was causing significant compression of the thecal sac. LITERATURE REVIEW Multiple reports have documented that DuraSeal(™), used as an adjunct to dural repair, can swell leading to compression of the spinal cord and/or neural elements. Our case demonstrates the use of DuraSeal(™) both over a site of a dural repair and over an annulotomy site, through which a TLIF was performed, is associated with the risk of developing postoperative cauda equina syndrome as a result of swelling of the DuraSeal(™). CLINICAL RELEVANCE Those using DuraSeal™ to seal off the annulotomy after a TLIF procedure performed with rhBMP-2 should use the product with an understanding of the potential postoperative swelling of the product and resulting neurologic sequela, particularly if DuraSeal(™) is used concomitantly at the site of dural repair.
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Affiliation(s)
- Brian J. Neuman
- Thomas Jefferson University/Rothman Institute, 1015 Walnut Street, Curtis Building, Suite 801, Philadelphia, PA 19107 USA
| | - Kristen Radcliff
- Thomas Jefferson University/Rothman Institute, 1015 Walnut Street, Curtis Building, Suite 801, Philadelphia, PA 19107 USA
| | - Jeffery Rihn
- Thomas Jefferson University/Rothman Institute, 1015 Walnut Street, Curtis Building, Suite 801, Philadelphia, PA 19107 USA
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Polyelectrolyte Complex Membranes for Prevention of Post-Surgical Adhesions in Neurosurgery. Ann Biomed Eng 2012; 40:1949-60. [DOI: 10.1007/s10439-012-0564-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/30/2012] [Indexed: 10/28/2022]
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Tarapore PE, Mukherjee P, Mummaneni PV, Ames CP. The appearance of dural sealants under MR imaging. AJNR Am J Neuroradiol 2012; 33:1530-3. [PMID: 22460340 DOI: 10.3174/ajnr.a3078] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Dural sealants are an adjunct to obtain watertight closure after intradural procedures. This study aims to characterize the appearance on MR imaging of 3 commonly employed dural sealants: fibrin glue, PEGH, and BSAG. To this end, patients who underwent spinal intradural procedures that included the use of dural sealant during closure were identified retrospectively. Post-operative data on 15 patients, including complications such as pseudomeningocele formation and infection, were gathered. The appearance of dural sealants on follow-up MR imaging scans within 3 days of surgery was analyzed. Fifteen patients were identified (5 with fibrin glue, 5 with PEGH, and 5 with BSAG applied during closure) with appropriately timed post-operative MR imaging scans. All 3 substances were identifiable based on anatomic location and imaging characteristics on post-operative MR imaging in standard T1, T1 PGFS, and T2 FSE. Definite differentiation between CSF and fibrin glue or PEGH was not possible with the T1 or T1 PGFS, or with the T2 FSE. Differences in intensity between CSF and BSAG were also not significant on either T1 sequence, but they were statistically significant on the T2 FSE. All patients had an uneventful post-operative course, and no patients developed post-operative pseudomeningocele at 30 days. This study concludes that water-based dural sealants such as fibrin glue and PEGH are difficult to differentiate from CSF on standard T1, T1 PGFS and T2 FSE, while BSAG is easily recognized on the T2 FSE. Recognition of water-based sealants therefore requires communication between the neurosurgeon and the neuroradiologist to avoid post-operative misidentification.
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Affiliation(s)
- P E Tarapore
- Department of Neurological Surgery and Radiology, University of California, San Francisco, San Francisco, CA 94143, USA.
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Chauvet D, Tran V, Mutlu G, George B, Allain JM. Study of dural suture watertightness: an in vitro comparison of different sealants. Acta Neurochir (Wien) 2011; 153:2465-72. [PMID: 21989779 DOI: 10.1007/s00701-011-1197-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 09/27/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND CSF leakages constitute a major complication of intradural procedures, especially for posterior fossa and skull base surgery. Dural suture watertightness is a decisive issue, and neurosurgeons routinely use different products to reinforce their dural closure. We have designed an experimental system capable of testing CSF leak pressure levels in order to compare two types of sutures in vitro and particularly four different sealants. METHODS Twenty-five fresh human cadaveric dural samples were removed and prepared for testing in a pressure chamber system connected to a hydraulic pressure motor. CSF leak levels were objectively registered. First, simple interrupted stitches were compared to running simple closure on 50-mm linear suture. Secondly, four sealants (two sealants/glues, Bioglue®, Duraseal®; two haemostatics, Tachosil®, Tissucol®) were tested. Statistical analysis was performed with paired Student's t-test. RESULTS No significant difference between interrupted closure and running suture was observed (p = 0.079). All sealants increased the watertightness of the suture significatively. However, comparison of the means of the differences for each product revealed large variations. In the conditions of our experiment, one sealant (Duraseal®) and one haemostatic (Tachosil®) seemed to show better results. We observed two different types of leakage: at the dura-sealant interface and through the sealant itself. CONCLUSIONS We have developed an experimental device capable of testing dural closure watertightness. Interrupted stitch suturing seemed no different from running simple closure. On the contrary, the sealants tested show different watertightness capacities.
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Affiliation(s)
- Dorian Chauvet
- Department of Neurosurgery, Groupe Hospitalier Pitié-Salpêtrière and Lariboisiere Hospital, 29 avenue Jean Moulin, 75014 Paris, France.
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Blackburn SL, Smyth MD. Hydrogel-induced cervicomedullary compression after posterior fossa decompression for Chiari malformation. Case report. J Neurosurg 2007; 106:302-4. [PMID: 17465365 DOI: 10.3171/ped.2007.106.4.302] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The use of an absorbable hydrogel dural sealant has been approved for neurosurgical applications with no published reports of complications to date. The authors present the case of a 13-year-old girl with syringomyelia and quadriparesis who underwent posterior fossa decompression and dural augmentation for Chiari malformation Type I. Dural closure was performed with a dural substitute patch, hydrogel dural sealant, and gelatin sponge. Magnetic resonance imaging, performed after initial postoperative improvement in the patient's quadriparesis deteriorated, demonstrated an expanding epidural mass collection causing cervicomedullary compression. Exploration on postoperative Day 15 revealed an expanded layer of hydrogel underlying a layer of gelatin sponge. The authors conclude that hydrogel dural sealants should be used cautiously in spaces that cannot tolerate significant mass effect.
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Affiliation(s)
- Spiros L Blackburn
- Department of Neurosurgery, Washington University, St. Louis Children's Hospital, St. Louis, Missouri 63110, USA.
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