The Fixed Combination of Collagen With Components of Fibrin Adhesive - A New Hemostypic Agent in Skull Base Procedures

Abstract

CSF leak still is one of the major sources of morbidity after extensive skull base procedures. Of the various standard closure techniques of traumatic or iatrogenic dural defects, none provides a really waterlight, persistent closure. Even the supplementary use of fluid fibrin glue did not substantially improve the rate of postoperative CSF leaks. The application of a collagen sheet covered with a fixed layer of solid components of a fibrin tissue glue (TachoComb(R)) overcomes the major drawbacks of dural sealing in skull base surgery. The dural defects of 58 patients undergoing extensive skull base procedures were sealed with this new hemostyptic agent. The series includes 44 patients undergoing primary surgery, 6 patients with traumatic or iatrogenic tears of venous sinuses, and 8 patients with postoperative leaks after previous skull base procedures in which other sealing methods were previously used. In the group of primary surgery, none of the patients had postoperative CSF leakage or venous rebleeding. One patient developed a delayed pneumatocephalus. All cases of patent CSF fistulas were resolved without any adjuvant therapy. Preliminary experience shows that the good sealing and hemostyptic performance of this new agent will considerably reduce the risk of postoperative CSF leak and infection after skull base procedures.

Watertightness and Effectiveness of a Fibrinogen-Based Collagen Fleece (TachoComb®) in Neurosurgery

“…We gained considerable experience with a fibrinogen-based collagen fleece, known as TachoComb ® (11,14,17,19,20,23). Our findings in 421 patients who received TachoComb ® proved it to be highly effective in achieving watertight dura sealing.…”

“…CSF leakage is a serious and well-recognized complication in brain surgery as well as skull-base surgery in which the integrity of the dura has been breached. Dural defects in the anterior, middle and posterior fossae cause CSF rhinorrhoea or otorrhoea (14,17). In many cases there is no clinically detectable leakage, and out of an unapparent defect meningitis, abscess formation, or pneumocephalus develops (14,17).…”

“…The main advantage of TachoComb ® is a rapid application with no need for extra fibrin glue for dural watertightness. TachoComb ® can also be used in larger dural defects as a dural substitute (14,17). Fibrin glue requires a dry application surface; otherwise a carrier for the activated glue is necessary.…”

“…TachoComb ® continues to be applied in endoscopic (23), vascular, thyroid, lung, hepatic, urological and ENT surgery, gynaecology and obstetrics (1,2,6,15), as well as in macroscopic and histological experimental studies (3,11,19,20) and in neurosurgery, where it serves as a dural substitute (14,17).…”

Effect of Thrombin Concentration on the Adhesion Strength and Clinical Application of Fibrin Glue-Soaked Sponge

“…Collagen sponge with fibrin glue has yielded good results in the prevention of CSF leakage. 9,11,13,14) We have used fibrin glue-soaked gelatin sponge (FGGS) for tissue sealing in neurosurgical practice, especially for transsphenoidal surgery, for more than 10 years.…”