Elsevier

Journal of Clinical Neuroscience

Volume 79, September 2020, Pages 144-147
Journal of Clinical Neuroscience

Short Communication
Hemopatch® with fibrin glue as a dural sealant in cranial and spinal surgery. A technical note with a review of the literature

https://doi.org/10.1016/j.jocn.2020.07.011Get rights and content

Highlights

Abstract

A major complication in cranial and spinal surgery is the post-operative occurrence of a cerebrospinal fluid (CSF) leak. Here we reported a technical note firstly describing the use of Hemopatch® with fibrin glue as a dural sealant in cranial and spinal neurosurgical procedures. Moreover we carried out a review of the literature. Further to the best of our knowledge this was the first series including patients submitted to different spinal surgeries in whom Hemopatch® was used as dural sealant. We prospectively collected the data of 22 patients. In all procedures, fibrin glue was applied after Hemopatch®. The mean age was 59.68 ± 10.79 years and the mean follow-up (FU) was 3.63 ± 1.46 months, respectively. Overall, Hemopatch® with fibrin glue was used in 8 cranial procedures (36.36%; all were retrosigmoid craniotomies) and 14 spinal procedures (63.64%). 9/14 spinal cases (64.28%) were incidental durotomies during a spinal decompression procedure. No CSF leak, no postoperative infection, no adverse reaction were observed during the FU in all cases. The literature search revealed only two retrospective series, reporting only patients submitted to cranial surgery for a total of 56 patients and a CSF leak occurring in 3 patients (5.35%). In conclusion, we firstly reported the feasibility and the safety of using Hemopatch® with fibrin glue as dural sealant in cranial surgery and different spinal procedures. Further larger comparative studies are needed to confirm our initial encouraging results.

Introduction

A major complication in cranial and spinal surgery is the post-operative occurrence of a cerebrospinal fluid (CSF) leak, which exposes patients to higher risk of infection, prolonged hospital stay and in many cases need of reoperation, thus increasing the healthcare costs [1], [2]. Many different closure techniques and biomaterials have been implemented with the aim of reducing the CSF leak rate in neurosurgery. The results of using Hemopatch® (Sealing Hemostat – Baxter Deutschland GmbH, Unterschleißheim, Germany), a novel advanced hemostatic pad with sealant properties [3], [4], as a dural sealant in neurosurgery have been reported only marginally [5], [6]. Moreover there are no published studies about the use of Hemopatch® in spine surgery. The aim of our study was to report our experience with Hemopatch® with fibrin glue in cranial and spinal procedures and carry out a review of the literature. To the best of our knowledge this was the first series in which Hemopatch® was used with fibrin glue. Moreover we firstly reported patients submitted to different spinal surgeries in whom Hemopatch® was used as dural sealant.

Section snippets

Materials and methods

The clinical data of 22 consecutive patients (10 males, 12 females) submitted to cranial or spinal surgery were prospectively collected from September 2019 to March 2020 (Table 1). The mean age was 59.68 ± 10.79 years and the mean follow-up (FU) was 3.63 ± 1.46 months, respectively. The patients included in our study had been submitted both to cranial (retrosigmoid craniotomy for the treatment of neurovascular conflict for trigeminal neuralgia) and spinal procedures (Table 1). All the

Results

Overall, we performed 8 cranial procedures (retrosigmoid craniotomy; 36.36%) and 14 spinal procedures (63.64%). Of the spinal cases, 2 patients underwent CSF leak repair for incidental durotomy during ACDF and 7 patients during MIPLD. In 4 patients Hemopatch® with fibrin glue was used in the closure of a lumbar laminotomy for the removal of IET and in 1 case to repair a post-operative lumbar pseudomeningocele. We did not observe any CSF collection during the FU. No wound infection nor adverse

Discussion

CSF leak represents a major problem in neurosurgery as it is associated with increased morbidity, need of surgical revisions and increased healthcare costs. Its incidence is variable and is linked to many factors such as the procedure performed, whether the opening of the dura is intentional or incidental and the type of closure technique. For example, the incidence of CSF leak after procedures in which dural opening is a part of the surgical approach ranges from 4% to 32% in craniotomies [1],

Limitations

Our study has some limitations due to the lack of a control group and the limited number of patients. Thus we were not able to establish if this closure technique is superior to other closure procedures. However the main goal of this study was to report the feasibility and safety of this procedure in different cranial and spinal procedures.

Conclusion

Our data evidenced the feasibility and the safety of using Hemopatch® with fibrin glue as dural sealant in cranial surgery and different spinal procedures. Further larger comparative studies are needed to confirm our initial encouraging results and the superiority of this technique over other closure procedures.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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