scholarly journals Sandwich wound closure reduces the risk of cerebrospinal fluid leaks in posterior fossa surgery

2016 ◽  
Vol 6 (2) ◽  
Author(s):  
Verena Heymanns ◽  
Abidemi W. Oseni ◽  
Ameer Alyeldien ◽  
Homajoun Maslehaty ◽  
Richard Parvin ◽  
...  
Keyword(s):  
New York ◽  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Wound Closure ◽  
Posterior Fossa Surgery ◽  
Dural Closure ◽  
Csf Leakage ◽  
Cerebrospinal Fluid Leaks ◽  
Closure Method ◽  
Csf Leaks

Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.

Cerebrospinal fluid leaks following spinal or posterior fossa surgery: use of fat grafts for prevention and repair

2000 ◽  
Vol 9 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Perry Black
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Effective Means ◽  
Fat Graft ◽  
Posterior Fossa Surgery ◽  
Dural Tear ◽  
Fat Grafts ◽  
Csf Leakage ◽  
Dural Tears ◽  
Csf Leaks

Cerebrospinal fluid (CSF) leaks are relatively common following spinal or posterior fossa surgery. A midline dural tear in the spine is readily repaired by direct application of a suture. However, far-lateral or ventral dural tears are problematic. Fat is an ideal sealant because it is impermeable to water. In this paper the author reports his experience with using fat grafts for the prevention or repair of CSF leaks and proposes a technique in which a large sheet of fat, harvested from the patient's subcutaneous layer, is used to cover not only the dural tear(s) but all of the exposed dura and is tucked into the lateral recess. This procedure prevents CSF from seeping around the fat, which may be tacked to the dura with a few sutures. Fibrin glue is spread on the surface of the fat and is further covered with Surgicel or Gelfoam. For ventral dural tears (associated with procedures in which disc material is excised), fat is packed into the disc space to seal off the ventra1 dural leak. Leaks in the posterior fossa are managed similarly to those in the spine. Dural suture lines, following suboccipital or spinal intradural exploration, are prophylatically protected from CSF leakage in the same manner. With one exception, 27 dural tears noted during 1650 spinal procedures were successfully repaired using this technique. There was one case of postoperative CSF leakage in 150 cases in which intradural exploration for tumor or other lesions was undertaken. Both postoperative CSF leaks were controlled by applying additional skin sutures. The use of a fat graft is recommended as a rapid, effective means of prevention and repair of CSF leaks following posterior fossa and spinal surgery.

Use of ligamentum nuchae graft for dural closure in posterior fossa surgery

1998 ◽  
Vol 89 (1) ◽  
pp. 155-156 ◽  
Author(s):  
Edward J. Kosnik
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Cerebrospinal Fluid Leakage ◽  
Posterior Fossa Surgery ◽  
Content Type ◽  
Fluid Leakage ◽  
Dural Closure ◽  
Fine Print

✓ The technique of harvesting the ligamentum nuchae and its use in posterior fossa surgery are discussed. By using this technique the author has avoided postoperative cerebrospinal fluid leakage in more than 200 procedures.

scholarly journals Cerebrospinal Fluid Leaks and Pseudomeningocele after Posterior Fossa Surgery: Effect of an Autospray Dural Sealant

Cureus ◽  
2020 ◽  
Author(s):  
Young M Lee ◽  
Angel Ordaz ◽  
Beata Durcanova ◽  
Jennifer A Viner ◽  
Philip V Theodosopoulos ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Posterior Fossa Surgery ◽  
Cerebrospinal Fluid Leaks

Polyethylene Glycol Hydrogel Dural Sealant May Reduce Incisional Cerebrospinal Fluid Leak after Posterior Fossa Surgery

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS182-ONS187 ◽  
Author(s):  
Khoi D. Than ◽  
Clinton J. Baird ◽  
Alessandro Olivi
Keyword(s):  
Cerebrospinal Fluid ◽  
Polyethylene Glycol ◽  
Fibrin Glue ◽  
Posterior Fossa ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
P Value ◽  
Posterior Fossa Surgery ◽  
Dural Closure ◽  
Fluid Leak

Abstract Objective: Incisional cerebrospinal fluid (CSF) leak remains a significant cause of morbidity, particularly after posterior fossa surgery, with ranges between 4 and 17% in most series. We aimed to determine whether the use of a new polyethylene glycol (PEG) dural sealant product (DuraSeal; Confluent Surgical, Waltham, MA) is effective at preventing incisional CSF leak after posterior fossa surgery. Methods: One hundred cases of posterior fossa surgery with the PEG dural sealant applied at the time of dural closure were prospectively observed from May 2005 to April 2006. All patients underwent posterior fossa craniotomy or craniectomy. Clinical histories were followed to document cases of incisional CSF leak, pseudomeningocele, meningitis, wound infection, and interventions required to treat a CSF leak or pseudomeningocele. A retrospective cohort of 100 patients treated in a similar fashion but with fibrin glue augmented dural closure served as controls. Results: In the PEG group, two of 100 (2%) patients developed an incisional CSF leak postoperatively. By comparison, 10 of 100 (10%) patients in whom fibrin glue was used developed an incisional CSF leak. This difference was statistically significant, with a P value of 0.03. There were no significant differences in the rates of pseudomeningocele, meningitis, or other postoperative interventions. Conclusion: The application of PEG dural sealant to the closed dural edges may be effective at reducing incisional CSF leak after posterior fossa surgery.

Endoscopic repair of cerebrospinal fluid leaks in the lateral sphenoid sinus recess

2010 ◽  
Vol 112 (2) ◽  
pp. 444-448 ◽  
Author(s):  
Boaz Forer ◽  
Dharmbir S. Sethi
Keyword(s):  
Cerebrospinal Fluid ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Endoscopic Repair ◽  
Singapore General Hospital ◽  
Csf Leakage ◽  
Transcranial Approach ◽  
Cerebrospinal Fluid Leaks ◽  
Skull Base Defect ◽  
Csf Leaks

Object Cerebrospinal fluid leaks may occur as a result of trauma or following surgery, and occasionally may also be spontaneous. Leakage of CSF from the lateral sphenoid recess is rare and challenging to treat. The authors present their experience with repairs of 10 CSF leaks that were confined to the lateral sphenoid recess and were treated at the Singapore General Hospital. Methods A retrospective chart review was conducted for all patients who underwent operations for lateral sphenoid recess CSF leaks between 2001 and 2008. Results Ten repairs were performed in 8 patients by using a transpterygoid approach, with a 90% success rate. In 3 cases the transcranial approach had failed prior to endoscopic repair. “Sandwich reconstruction” under direct vision was performed in all cases, and was completed using cartilage or bone as a rigid support. Conclusions This series demonstrates that CSF leakage can be managed safely and effectively by using an endoscopic transpterygoid approach in patients in whom both external and endoscopic attempts have failed. The transpterygoid approach used in all of the cases in this series provides wide exposure around the skull base defect, which is crucial for successful repair.

The safety and effectiveness of a dural sealant system for use with nonautologous duraplasty materials

2010 ◽  
Vol 112 (2) ◽  
pp. 428-433 ◽  
Author(s):  
Jason S. Weinstein ◽  
Kenneth C. Liu ◽  
Johnny B. Delashaw ◽  
Kim J. Burchiel ◽  
Harry R. van Loveren ◽  
...  
Keyword(s):  
Polyethylene Glycol ◽  
Adverse Events ◽  
Surgical Site Infections ◽  
Study Group ◽  
Pivotal Trial ◽  
Safety And Efficacy ◽  
Dural Closure ◽  
System A ◽  
Csf Leakage ◽  
Csf Leaks

Object The DuraSeal dural sealant system, a polyethylene glycol hydrogel, has been shown to be safe and effective when used with commercial and autologous duraplasty materials. The authors report on the safety and effectiveness of this sealant when used in conjunction with nonautologous duraplasty materials. Methods In this retrospective, nonrandomized, multicenter study, the safety and efficacy of a dural sealant system was assessed in conjunction with primarily collagen-based nonautologous duraplasty materials in a sample of 66 patients undergoing elective cranial procedures at 3 institutions. This cohort was compared with 50 well-matched patients from the DuraSeal Pivotal Trial who were treated with this sealant system and autologous duraplasty material. Results The key end points of the study were the incidences of CSF leaks, surgical site infections, and meningitis 90 days after surgery. The incidence of postoperative CSF leakage was 7.6% in the study group (retrospective population) and 6.0% in the Pivotal Trial population. The incidence of meningitis was 0% and 4.0% in the retrospective and Pivotal Trial groups, respectively. There were no serious device-related adverse events or unanticipated adverse device effects noted for either population. Conclusions This study demonstrates that the DuraSeal sealant system is safe and effective when used for watertight dural closure in conjunction with nonautologous duraplasty materials.

scholarly journals Single-Arm, Open-Label, Multicenter Study to Evaluate the Safety and Performance of Dura Sealant Patch in Reducing Cerebrospinal Fluid Leakage Following Elective Cranial Surgery: The ENCASE Trial Study Protocol

Neurosurgery ◽  
2019 ◽  
Author(s):  
Tristan P C van Doormaal ◽  
Menno R Germans ◽  
Mariska Sie ◽  
Bart Brouwers ◽  
Jorn Fierstra ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Primary Endpoint ◽  
Multicenter Study ◽  
Controlled Trial ◽  
Cerebrospinal Fluid Leakage ◽  
Open Label ◽  
Cranial Surgery ◽  
Dural Closure ◽  
Csf Leakage ◽  
And Performance

Abstract BACKGROUND Cerebrospinal fluid (CSF) leakage is one of the most common neurosurgical complications, occurring in 4% to 32% of surgical cases, with a higher incidence in complicated skull base surgery, intradural spine surgery, and the surgery of the posterior fossa. Our group developed a Dural Sealant Patch (DSP) for watertight dural closure after cranial surgery. OBJECTIVE To clinically study for the first time the safety and performance of the DSP as a means of reducing CSF leakage in patients undergoing elective cranial intradural surgery with a dural closure procedure. METHODS We will conduct an open-label, single-arm, multicenter study with a 360 d (12 mo) follow-up. A total of 40 patients will be enrolled at 3 sites. The primary endpoint is a combination of occurrences of one of the following events: postoperative percutaneous CSF leakage, intraoperative leakage at 20 cm H2O, or postoperative wound infection. The secondary endpoints are pseudomeningocele and thickness of dura + DSP. EXPECTED OUTCOMES Not more than 3 patients will meet the primary endpoint suggesting safety and efficacy. DISCUSSION As a next step, a randomized controlled trial against the best current practice will follow to evaluate if DSP reduces CSF leakage while its safety is noninferior.

Comparison of Spontaneous Temporal Bone Cerebrospinal Fluid Leaks From the Middle and Posterior Fossa

2019 ◽  
pp. 1
Author(s):  
Timothy Cooper ◽  
Matthew H. Choy ◽  
Paul A. Gardner ◽  
Barry E. Hirsch ◽  
Andrew A. McCall
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Bone ◽  
Posterior Fossa ◽  
Cerebrospinal Fluid Leaks
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