Evaluate the safety and efficacy of dura sealant patch in reducing cerebrospinal fluid leakage following elective cranial surgery (ENCASE II): study protocol for a randomized, two-arm, multicenter trial

BACKGROUND

Cerebrospinal fluid (CSF) leakage is a frequent and challenging complication in neurosurgery, especially in the posterior fossa, with a prevalence of 8%. It is associated with substantial morbidity and increased healthcare costs. A novel dural sealant patch (LIQOSEAL) was developed for watertight dural closure. The objective of this study is to clinically assess the safety and effectiveness of LIQOSEAL as a means of reducing intra- as well as postoperative CSF leakage in patients undergoing elective posterior fossa intradural surgery with a dural closure procedure compared to the best currently available dural sealants.

METHODS

We will conduct a two-arm, randomized controlled, multicenter study with a 90-day follow-up. A total of 228 patients will be enrolled in 19 sites, of which 114 will receive LIQOSEAL and 114 an FDA-approved PEG sealant. The composite primary endpoint is defined as intraoperative CSF leakage at PEEP 20 cm H₂O, percutaneous CSF leakage within 90 days of, wound infection within 90 days of or pseudomeningocele of more than 20cc on MRI or requiring intervention. We hypothesize that the primary endpoint will not be reached by more than 10 patients (9%) in the investigational arm, which will demonstrate non-inferiority of LIQOSEAL compared to control.

DISCUSSION

This trial will evaluate whether LIQOSEAL is non-inferior to control as a means of reducing CSF leakage and safety TRIAL REGISTRATION: ClinicalTrials.gov NCT04086550 . Registered on 11 September 2019.

Endovascular Treatment of a Giant Petrous Internal Carotid Artery Aneurysm

Expansive aneurysms of the petrous internal carotid artery are rare. Compressive and thrombembolic neurological deficits and occasionally extradural haemorrhage in combination with a pulsatile tinnitus are most important and alarming symptoms. Due to its extradural location, subarachnoid haemorrhage does not occur. Treatment is indicated since rupture may be devastating and recurrent ischaemic attacks severely disabling. Because direct neurosurgical access to the petrous internal carotid artery is very difficult, treatments consists of parent vessel occlusion with or without extra-intracranial bypass construction. We present a case of a young man with a giant petrous artery aneurysm provoking a thrombembolic event which was treated successfully with proximal balloon occlusion of the internal carotid artery after a temporary balloon occlusion test.

Objective pulsatile tinnitus caused by intrapetrous dissecting aneurysm

Intrapetrosal dissections is a special kind of intracranial dissection since it is located intracranially but extradurally. Only three reports of spontaneous intrapetrosal dissection have been published so far, the posttraumatic intrapetrosal dissections caused by penetrating or blunt trauma not included. Based on the clinical and radiological presentation a treatment with anticoagulantia (a coumarine derivative) was successfully installed. A short review of the major studies concerning intracranial dissection is presented. Firm guidelines for the treatment cannot be provided based on these data but the etiology of the dissection, whether it was posttraumatic or spontaneous, seems to be important. The diagnostic problem of pulsatile tinnitus is briefly discussed.

The use of Emla cream as anaesthetic for minor urological surgery in children

A number of minor urological surgical procedures can be readily carried out in children in outpatient clinics with the availability of a good topical local anaesthetic. In boys, the separation of preputial adhesions, frenulotomy, meatoplasty, meatal dilatation following circumcision or meatal surgery, the removal of smegma and excision of penile skin lesions can be performed as outpatient treatment. In girls, hymenal abnormalities, meatal abnormalities and labial adhesions come into consideration for its use. Success is dependent on a good estimation of the mental capacity of the child to undergo a local surgical procedure and correct use of the anaesthetic.