Short CommunicationHemopatch® with fibrin glue as a dural sealant in cranial and spinal surgery. A technical note with a review of the literature
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.
References (17)
- et al.
Hemopatch® as a new dural sealant: a clinical observation
Clin Neurol Neurosurg
(2019) - et al.
Evaluation of the use of BioGlue in neurosurgical procedures
J Clin Neurosci
(2003) - et al.
Complications necessitating a return to the operating room following intradural spine surgery
World Neurosurg
(2012) - et al.
Spinal meningiomas: surgical outcome and literature review
Neurochirurgie
(2013) - et al.
The role of laminoplasty in preventing spinal deformity in adult patients submitted to resection of an intradural spinal tumor. Case series and literature review
Clin Neurol Neurosurg
(2014) - et al.
A short review on a complication of lumbar spine surgery: CSF leak
Clin Neurol Neurosurg
(2015) - et al.
Results of TachoSil® associated with fibrin glue as dural sealant in a series of patients with spinal intradural tumors surgery. Technical note with a review of the literature
J Clin Neurosci
(2019) - et al.
Risk factors for postoperative CSF leakage after elective craniotomy and the efficacy of fleece-bound tissue sealing against dural suturing alone: a randomized controlled trial
J Neurosurg
(2014)