Autologous fibrin glue in the repair of dural defects in craniofacial resections

1992 ◽  
Vol 106 (4) ◽  
pp. 356-357 ◽  
Author(s):  
Abbad G. Toma ◽  
Edward W. Fisher ◽  
Anthony D. Cheesman
Keyword(s):  
Cerebrospinal Fluid ◽  
Fibrin Glue ◽  
Cerebrospinal Fluid Leakage ◽  
Craniofacial Resection ◽  
Simple Method ◽  
Dural Repair ◽  
Fluid Leakage ◽  
Csf Leakage ◽  
Autologous Fibrin Glue ◽  
Dural Defects

AbstractCerebrospinal fluid leakage is a serious and well recognized complication of craniofacial resection for ethmoidal tumours in which the integrity of the dura has been breached. Autologous fibrin glue is a safe, inexpensive and simple method of improving the seal of dural repair and hence minizing CSF leakage. The principles and method of autologous fibrin glue preparation are described. The technique has proven satisfactory in 20 consecutive craniofacial resections with dural defects and is recommended as an adjunct to current techniques of dural repair.

Cerebrospinal fluid leakage into the subdural space: possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma

2008 ◽  
Vol 108 (2) ◽  
pp. 275-280 ◽  
Author(s):  
Rudolf A. Kristof ◽  
Jochen M. Grimm ◽  
Birgit Stoffel-Wagner
Keyword(s):  
Cerebrospinal Fluid ◽  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Postoperative Recurrence ◽  
Cerebrospinal Fluid Leakage ◽  
Subdural Space ◽  
Subdural Hygroma ◽  
Fluid Leakage ◽  
Csf Leakage

Object The purpose of this study was to clarify whether cerebrospinal fluid (CSF) leakage into the subdural space is involved in the genesis of chronic subdural hematoma (CSDH) and subdural hygroma (SH) and to clarify whether this leakage of CSF into the subdural space influences the postoperative recurrence rate of CSDH and SH. Methods In this prospective observational study, 75 cases involving patients treated surgically for CSDH (67 patients) or SH (8 patients) were evaluated with respect to clinical and radiological findings at presentation, the content of β -trace protein (β TP) in the subdural fluid (βTPSF) and serum (βTPSER), and the CSDH/SH recurrence rate. The βTPSF was considered to indicate an admixture of CSF to the subdural fluid if βTPSF/βTPSER > 2. Results The median β TPSF level for the whole patient group was 4.29 mg/L (range 0.33–51 mg/L). Cerebrospinal fluid leakage, as indicated by βTPSF/βTPSER > 2, was found to be present in 93% of the patients with CSDH and in 100% of the patients with SH (p = 0.724). In patients who later had to undergo repeated surgery for recurrence of CSDH/SH, the βTPSF concentrations (median 6.69 mg/L, range 0.59–51 mg/L) were significantly higher (p = 0.04) than in patients not requiring reoperation (median 4.12 mg/L, range 0.33–26.8 mg/L). Conclusions As indicated by the presence of βTP in the subdural fluid, CSF leakage into the subdural space is present in the vast majority of patients with CSDH and SH. This leakage could be involved in the pathogenesis of CSDH and SH. Patients who experience recurrences of CSDH and SH have significantly higher concentrations of βTPSF at initial presentation than patients not requiring reoperation for recurrence. These findings are presented in the literature for the first time and have to be confirmed and expanded upon by further studies.

Prophylactic Percutaneous Sealing of Lumbar Postdural Puncture Hole with Fibrin Glue to Prevent Cerebrospinal Fluid Leakage in Swine

2000 ◽  
Vol 90 (4) ◽  
pp. 894-898 ◽  
Author(s):  
Roberto García-Aguado ◽  
Francisco Gil ◽  
Juan A. Barcia ◽  
José Aznar ◽  
Francisco Hostalet ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Fibrin Glue ◽  
Cerebrospinal Fluid Leakage ◽  
Fluid Leakage

The effects of topical granulocyte-macrophage colony–stimulating factor on dural healing in rats after induced cerebrospinal fluid leakage

2007 ◽  
Vol 7 (4) ◽  
pp. 419-422
Author(s):  
Gökhan Kurt ◽  
Alp Özgün Börcek ◽  
Berker Cemil ◽  
NeşE Lortlar Uçankuş ◽  
Fikret Doğulu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leakage ◽  
Colony Stimulating Factor ◽  
Gm Csf ◽  
Fluid Leakage ◽  
Recombinant Mouse ◽  
Macrophage Colony Stimulating Factor ◽  
Macrophage Colony ◽  
Dural Defects ◽  
Stimulating Factor

Object Dural defects must be repaired to protect the central nervous system from contamination. Although there are various experimental and commercial substances available for this purpose, the ultimate method of watertight dural closure has yet to be discovered. In this study, the authors investigate the effects of topically applied recombinant mouse granulocyte-macrophage colony–stimulating factor (GM-CSF) on dural healing in a rat model of dural injury and cerebrospinal fluid leakage. Methods In this experimental model, a dural defect at the level of the L1–2 vertebrae was created in 32 Wistar rats. Sixteen animals were treated with locally applied recombinant mouse GM-CSF postoperatively, and 16 animals received normal saline. The effects of GM-CSF on dural healing, cerebrospinal fluid leakage, and wound healing were assessed 2 and 4 weeks postoperatively. Dural healing was evaluated histologically. Results Dural healing was increased in rats treated with GM-CSF compared with rats in the control group. This difference was statistically significant (p < 0.05). Conclusions Cerebrospinal fluid leakage may impede healing of dural defects. Topically applied GM-CSF seems to aid in dural healing.

scholarly journals Cerebrospinal fluid leakage repair of various grades developing during endoscopic transnasal transsphenoidal surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248229
Author(s):  
Il Hwan Lee ◽  
Do Hyun Kim ◽  
Jae-Sung Park ◽  
Sin-Soo Jeun ◽  
Yong-Kil Hong ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Retrospective Chart Review ◽  
Pedicled Flap ◽  
Cerebrospinal Fluid Leakage ◽  
Dural Defect ◽  
Endoscopic Endonasal ◽  
Tertiary Referral Center ◽  
Fluid Leakage ◽  
Csf Leakage ◽  
Grade 3

Objectives We describe the strategy used to repair intraoperative leaks of various grades and define factors for preventing postoperative cerebrospinal fluid leakage (CSF) after surgery via the endoscopic endonasal transsphenoidal approach (EETA). Study design Retrospective chart review at a tertiary referral center. Methods Patients who underwent surgery via EETA from January 2009 to May 2020 were retrospectively reviewed. Intraoperative CSF leakage was graded 0–3 in terms of the dural defect size; various repairs were used depending on the grade. Results A total of 777 patients underwent 869 operations via EETA; 609 (70.1%) experienced no intraoperative CSF leakage (grade 0) but 260 (29.9%) did. Leakage was of grade 1 in 135 cases (15.5%), grade 2 in 83 (9.6%), and grade 3 in 42 (4.8%). In 260 patients with intraoperative CSF leakage, a buttress was wedged into the sellar defect site in 178 cases (68.5%) and a pedicled flap was placed in 105 cases (40.4%). Autologous fat (108 cases, 41.5%) and a synthetic dural substitute (91 cases, 35%) were used to fill the dead space of the sellar resection cavity. Postoperative CSF leakage developed in 21 patients: 6 of grade 1, 7 of grade 2, and 8 of grade 3. Buttress placement significantly decreased postoperative leakage in grade 1 patients (p = 0.041). In patients of perioperative leakage grades 2 and 3, postoperative CSF leakage was significantly reduced only when both fat and a buttress were applied (p = 0.042 and p = 0.043, respectively). Conclusion A buttress prevented postoperative CSF leakage in grade 1 patients; both fat and buttress were required by patients with intraoperative leakage of grades 2 and 3.

scholarly journals Utility of nonpenetrating titanium clips for dural closure during spinal surgery to prevent postoperative cerebrospinal fluid leakage

2015 ◽  
Vol 23 (6) ◽  
pp. 812-819 ◽  
Author(s):  
Kiyoshi Ito ◽  
Tatsuro Aoyama ◽  
Tetsuyoshi Horiuchi ◽  
Kazuhiro Hongo
Keyword(s):  
Cerebrospinal Fluid ◽  
Dura Mater ◽  
Spinal Surgery ◽  
Water Pressure ◽  
Cerebrospinal Fluid Leakage ◽  
Fluid Leakage ◽  
Dural Closure ◽  
Significant Difference ◽  
Csf Leakage ◽  
Titanium Clips

OBJECT The nonpenetrating titanium clip has been successfully used in peripheral arterial bypass surgery. The purpose of this study was to evaluate the leakage pressures and patterns of nonpenetrating titanium clips using a simple model that mimicked spinal surgery. In addition, the authors describe their surgical experience with these clips and the follow-up results in 31 consecutive patients. METHODS The authors compared nonpenetrating titanium clips and expanded polytetrafluoroethylene (ePTFE) sutures in relation to the water pressure that could be tolerated by sutured ePTFE sheets, and the leakage pressure patterns were determined. The changes in leakage pressures at 5 minutes, 30 minutes, and 12 hours were examined when the clips and sutures were used in combination with the mesh-and-glue technique in an in vitro study. Thirty-one patients underwent spinal intradural procedures using nonpenetrating titanium clips to suture the dura maters using the meshand-glue technique, involving fibrin glue and polyglycolic acid-fibrin sheets. RESULTS A significant difference was apparent between the ePTFE suture group and the nonpenetrating titanium clip group, with the latter showing a leakage pressure that could be sustained and was 1508% higher than that of the former (p = 0.001). In relation to leakage patterns, the nonpenetrating titanium clips did not make any suture holes in the ePTFE sheet and fluid leakage occurred between the clips, whereas fluid leakage was associated with the pressure elevation that occurred at the suture holes made by the ePTFE sutures. Of the 31 patients who underwent spinal intradural procedures using nonpenetrating titanium clips, 1 (3.2%) experienced cerebrospinal fluid (CSF) leakage postoperatively. No other complications—for example, allergic reactions, adhesions, or infections—were encountered. CONCLUSIONS The interrupted placement of nonpenetrating titanium clips enables dural closure without creating any holes. These clips facilitate improvements in the initial leakage pressure and reduce postoperative CSF leakage following spinal surgery. The authors conclude that it is very beneficial to suture the spinal dura mater using nonpenetrating titanium clips given the anatomical characteristics of the spinal dura mater and the fact that the clips do not create suture holes.

scholarly journals Development of severe hyponatremia due to cerebrospinal fluid leakage following meningomyelocele surgery in a newborn

2018 ◽  
Vol 21 (6) ◽  
pp. 597-600
Author(s):  
Ismail Kürşad Gökce ◽  
Hatice Turgut ◽  
Ramazan Ozdemir ◽  
Selami Cagatay Onal
Keyword(s):  
Cerebrospinal Fluid ◽  
Wound Dehiscence ◽  
Sodium Content ◽  
Dietary Sodium ◽  
Cerebrospinal Fluid Leakage ◽  
Neurodevelopmental Outcomes ◽  
Newborn Period ◽  
Severe Hyponatremia ◽  
Fluid Leakage ◽  
Csf Leakage

Cerebrospinal fluid leakage following meningomyelocele surgery is a frequent complication in the wound-healing period and is associated with wound dehiscence. CSF loss can cause severe hyponatremia, especially in the newborn and early infancy periods when dietary sodium content is relatively low. Hyponatremia in the newborn period can result in adverse neurodevelopmental outcomes. In addition, hyponatremia’s cerebral effects can increase complications in neurosurgery patients. The authors present the case of a newborn in whom CSF leakage from the operative site and severe hyponatremia developed following meningomyelocele surgery. To the best of their knowledge, severe hyponatremia caused by CSF leakage after meningomyelocele surgery has not been previously reported in the literature.

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