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

Abstract

Background: Meningitis or cerebrospinal fluid rhinorrhoea can occur years or even decades after trauma or operation and can be the first indication of a previously unidentified dural lesion. Preventing cerebrospinal fluid (CSF) leakage with a fibrinogen-based collagen fleece (TachoComb ® ) was the interest of our clinical study. Methods: In the present study, we examined the watertightness and effectiveness of TachoComb ® following supratentorial/infratentorial as well as skull-base operations. The dura was closed primarily by sutures and covered with a fibrinogen-based collagen fleece to prevent CSF leakage. Results: Twelve patients developed a subcutaneous CSF collection requiring no further treatment, seven patients were managed by lumbar CSF drainages, and three patients had to be reoperated. Conclusions: Based on these results, we proved the watertightness and effectiveness of this fibrinogen-based collagen fleece. (Eur. Surg. 2003; 35:278-281) Wasserdichtheit und klinische Verwendung von TachoComb ® in der Neurochirurgie Zusammenfassung: Grundlagen: Eine Meningitis oder eine Liquorfistel kann Jahre bis Jahrzehnte nach einem Trauma oder einer neurochirurgischen Operation erstmalig auftreten. Als Prophylaxe gegen eine Liquorfistel haben wir ein resorbierbares Kollagenvlies, das mit Bestandteilen eines Fibrinklebers beschichtet ist (TachoComb ® ) klinisch getestet. Methodik: In unserer vorliegenden Studie haben wir die Wasserdichtheit von TachoComb ® in 421 Fällen getestet. Die primär vernähte Dura mater wurde mit einem beschichteten Kollagenvlies bedeckt, ebenso die Schädelbasis nach Schädelba-sisoperationen. Ergebnisse: 12 Patienten entwickelten ein subcutanes Liquorkissen, welches keiner weiteren Therapie bedurfte. In 7 Fällen wurden die Patienten mit einer Lumbaldrainage behandelt und in 3 Fällen mußte reoperiert werden um den Defekt zu decken. Schlussfolgerungen: Basierend auf diesen Ergebnissen kön-nen wir die Verwendung von TachoComb ® zum Erreichen eines wasserdichten Duraverschlusses empfehlen.

Sealants (Adhesives) to Prevent Bleeding

“…The operations were performed on various organs, such as the liver, vascular system, heart, spleen, thorax, and kidney, and the results supported the effi cacy and safety of TachoSil as a hemostatic agent. TachoComb ® has been used as a dural substitute, and a clinical study of 288 patients revealed no superfi cial or deep wound infections or aseptic meningitis [ 24 ] .…”

Multiple uses of fibrin sealant for nervous system treatment following injury and disease

“…Thus, a combination of collagen and FS is effective, safe and biocompatible. No further adverse events, complications or toxicity were reported [ 14 – 16 , 28 , 29 ].…”

Foreign Body Granuloma Mimicking Upper Cervical Spinal Mass after Dural Repair with Tachocomp: A Case Report

“…Therefore, all donors were carefully selected. Although no undesirable effects caused by the fibrinogen-based collagen sponge Tachocomb have occurred until now, the possibility of hypersensitivity and allergic or anaphylactic reactions cannot be excluded completely [13,14,15]. However, it is reported that collagen-based heterologous products have a double advantage: the first one is that it does not initiate an inflammatory response or a foreign body reaction and the second is that the collagen fiber network acts as a matrix for endogenous neodura growth [16,17].…”