Usefulness of Sealants for Dural Closure: Evaluation in an In Vitro Model

Doormaal, Tristan van; Kinaci, Ahmet; Thoor, Sander van; Redegeld, Saskia; Bergmann, Werner; Zwan, Albert van der

doi:10.1093/ons/opx260

Cited by 29 publications

(45 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the only preclinical trial that directly compared the burst pressure of these two sealants, van Doormaal et al used porcine dura as well as one of nine commonly used sealants. 2 The authors found that the mean burst pressure of Adherus Emotional (0-10) 1.5 1.7…”

Section: Discussionmentioning

confidence: 99%

“…Adherus has been shown to have high burst strength (87 AE 47 mm Hg) when compared with other sealants used for dural closure including Tachosil (Baxter, Deerfield, Illinois, United States) and Duraseal (Integra LifeSciences Corporation, Plainsboro, New Jersey, United States), which have demonstrated burst pressures of 71 AE 16 mm Hg and 51 AE 42 mm Hg, respectively. 2 To date, there have been a limited number of studies examining the role of Adherus in skull base reconstruction. We hypothesize that Adherus is a reasonable alternative to other traditional dural sealants in ESBS.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Adherus Dural Sealant in Endoscopic Skull Base Surgery: Safety, Imaging Characteristics, and Sinonasal Quality of Life

Soneru

Riley

Minkowitz

et al. 2019

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

Objective This study was aimed to compare the safety profiles, magnetic resonance imaging (MRI) findings, and sinonasal outcome test (SNOT-22) scores of Adherus dural sealant, a novel tissue glue designed for skull base surgery. Design Present study is a prospective case series. Setting The research work took place at a tertiary-care academic medical center. Participants Consecutive series of 26 patients undergoing endoscopic skull base surgery (ESBS) with Adherus was compared with a control group of 24 patients matched for tumor type and size with DuraSeal as a sealant. Main Outcome Measures Postoperative complication rates, imaging characteristics, and postoperative SNOT-22 scores were measured and compared. Results No postoperative cerebrospinal fluid (CSF) leaks, intracranial hemorrhages, or mucoceles were observed in either cohort. Adherus was more likely to be identifiable on immediate postoperative MRI (50 vs. 20.8%, p = 0.032). In patients in whom a nasoseptal flap was utilized, the flap was opposed to the skull base in all cases regardless of sealant selected. Postoperative SNOT-22 total (17.25 [±10.81] vs. 14.85 [±14.22], p = 0.609) and subdomain scores were similar between the two groups. Conclusions Adherus dural sealant appears to be a safe alternative to Duraseal in ESBS with comparable quality of life outcomes and imaging findings. These preliminary results are promising but should be examined in a larger population with long-term follow-up.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adherus Dural Sealant in Endoscopic Skull Base Surgery: Safety, Imaging Characteristics, and Sinonasal Quality of Life

Soneru

Riley

Minkowitz

et al. 2019

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

show abstract

“…Dura closure can be done through different types of sealant techniques and substitutes preventing CSF leakage, which occurs in 4 to 32% in all cranial surgeries. 15 This complication has been correlated with meningitis, delayed wound healing, epidural infections, and pneumochephalus. 16 A recent systematic review by Kinaci et al concluded no statistical significant difference in CSF leakage with the use of dural sealants compared with no sealants.…”

Section: Discussionmentioning

confidence: 99%

En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive Approach

Egeler

Johnson

et al. 2019

J Reconstr Microsurg Open

View full text Add to dashboard Cite

Background This study analyzes the surgical outcomes for single setting surgeries involving en-bloc solitary calvarial tumor resection in combination with three-layered reconstruction, presenting a novel planning algorithm. Methods Data were retrieved for all patients undergoing single-stage tumor excision, using our novel three-layered reconstructive approach (duraplasty, cranioplasty, and soft tissue reconstruction) between 2005 and 2017 at a single tertiary hospital center. Patients ≥18 years with a Karnofsky Performance score (KPS) >70 and a life expectancy of > 2 months were included. Patient characteristics, surgical specifics, histological diagnoses, outcomes, and complications were reviewed. Results Eighteen single-staged excisions and three-layered reconstructions were performed. Seven patients presented with primary tumors and 11 patients with metastases. Mean age was 62 years. Mean follow-up time was 39 months. Primary closure was used in 12 of 18 patients, microvascular free flap with skin grafting in 4 of 18, and local advancement or rotational flap in 2 of 18. Two compromised free flaps were revised. There was no flap necrosis, skin graft failure, or wound infection observed in this series. Neurosurgical complications included two cases with seizures, one sublesional intraparenchymal hematoma, one adjacent parenchymal infarct, one case of delayed postradiation cerebrospinal fluid leakage, and one case of subdural hemorrhage. Conclusion En-bloc excision followed by three-layered reconstruction is a feasible and often suitable single-stage technique for complex solitary metastasis or primary calvarial tumors, which historically have been challenging to treat. It can offer an alternative approach to primary and metastatic calvarial tumors other than palliative treatment or hospice care.

show abstract

“…In vitro studies provided an explanation for these results, which showed that most currently dural sealants do not seal the dura sufficiently. Hereto, our group tested nine commonly used dural sealants on fresh porcine dura in a standardized in vitro cranial burst pressure model [26]. The maximum acute pressure sealants could resist and the chronic resistance of the sealants in physiological conditions (humid environment, the continuous temperature at 37 •C and triphasic intracranial pressure between 6 and 16 mmHg) for 72 h were tested in two different setups.…”

Section: Dural Sealant Efficacymentioning

confidence: 99%

“…The maximum acute pressure sealants could resist and the chronic resistance of the sealants in physiological conditions (humid environment, the continuous temperature at 37 •C and triphasic intracranial pressure between 6 and 16 mmHg) for 72 h were tested in two different setups. Out of nine different sealants tested, three could resist physiological intracranial pressure (16 mmHg), of which only two could resist prolonged physiological conditions for 72 h [26]. These two sealants were both liquid PEG sealants, which are associated with swelling and are contraindicated in confined anatomical spaces [27,28].…”

Section: Dural Sealant Efficacymentioning

confidence: 99%

Dural sealants for the management of cerebrospinal fluid leakage after intradural surgery: current status and future perspectives

Kinaci

Doormaal

2019

Expert Review of Medical Devices

Self Cite

View full text Add to dashboard Cite

Introduction: Cerebrospinal fluid leakage is a complication after intradural surgery and is associated with severe secondary complications like compromised wound healing and meningitis. Dural sealants are meant to augment the primary dural closure in order to achieve a watertight closure. Areas covered: This review summarizes the efficacy of currently available dural sealants. Potential future improvements and biomaterials are discussed. Expert opinion: The use of a dural sealant seems to be the logical method to prevent CSF leakage. However, based on the efficacy of currently available dural sealants according to systematic reviews and in vitro studies, a significant effective dural sealant seems is still lacking. A new dural sealant has to be thoroughly assessed before clinical application in in vitro, in vivo and clinical trials. A new research area within sealant development might be the introduction of dural sealants with both antimicrobial and analgesic properties.

show abstract

Usefulness of Sealants for Dural Closure: Evaluation in an In Vitro Model

Abstract: Given the high cost of sealants and the results of this study, we advocate a critical attitude toward sealant application as an adjunct to classic dural closure.

Cited by 29 publications

References 5 publications

Adherus Dural Sealant in Endoscopic Skull Base Surgery: Safety, Imaging Characteristics, and Sinonasal Quality of Life

Adherus Dural Sealant in Endoscopic Skull Base Surgery: Safety, Imaging Characteristics, and Sinonasal Quality of Life

En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive Approach

Dural sealants for the management of cerebrospinal fluid leakage after intradural surgery: current status and future perspectives

Contact Info

Product

Resources

About