Comparative study of fibrin and chemical synthetic sealant on dural regeneration and brain damage

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Several materials, such as polyethylene glycol (PEG) hydrogel and fibrin glue, have been used to seal dural incisions after brain and spinal surgeries. Although the use of PEG sealant is gaining popularity, it can be associated with postoperative cerebrospinal fluid leakage and infection. However, the reasons for this association are currently unknown. The present study aimed to investigate the effects of PEG sealant and fibrin glue on wound healing and brain damage in vivo.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Oval-shaped bone defects and dural defects were created bilaterally over the parietal lobes of 22 Japanese white rabbits. The dural defects were covered with 0.5 ml of fibrin glue on one side and 0.5 ml of PEG sealant on the other side. Dural regeneration and brain damage were investigated in each harvested brain and dura mater using light microscopy.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Dural regeneration was more effective in the presence of fibrin glue than it was with PEG sealant (p = 0.014). Of the 22 rabbits, 11 showed thick (Grades ++ and +++) dural regeneration by 28 days postsurgery in the hemisphere where fibrin glue was used, whereas Grade +++ dural regeneration was not observed in the PEG hydrogel hemisphere, and only 4 rabbits showed Grade ++ regeneration. Abscess and granulation formation also tended to be more severe when PEG hydrogel sealant was used. No Grade ++ granulation/abscess formation was observed with fibrin glue, and Grade + was only observed in 13 of 22 rabbits. Conversely, with PEG hydrogel sealant, only 2 rabbits did not show granulation/abscess formation, and Grade +, ++, and +++ granulation/abscess formation was observed in 8, 7, and 5 rabbits, respectively. The extent of cortical damage was significantly greater in rabbits with abscesses and granulations, compared with rabbits without these lesions (p = 0.007).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Dural regeneration tended to occur more rapidly with fibrin glue, whereas granulation was more likely with PEG hydrogel sealant, which led to postoperative complications. Histological analysis indicated that PEG hydrogel sealant inhibited the normal tissue healing process and that outcomes were improved by the use of fibrin glue.</jats:p></jats:sec>

Pseudomeningocele formation following chiari decompression: 19-year retrospective review of predisposing and prognostic factors

“…This also corresponded with higher rates of abscess and granulation tissue formation in the PEG group. [ 14 ] While the current investigation was not sufficiently powered to demonstrate a difference among the difference sealants used, we believe our data corroborates a growing body of literature implicating these agents in wound healing complications. This represents a correlation of spinal fluid leaks with the use of sealant.…”

Association between synthetic sealants and increased complication rates in posterior fossa decompression with duraplasty for Chiari malformations regardless of graft type

“…They showed that granulation tissue and abscess formation were significantly more severe with DuraSeal, with a massive infiltration of neutrophils. 32 These studies, along with our results and others, 25,28 may explain the higher rate of certain complications seen when combining Durepair and DuraSeal.…”

Histological effects of fibrin glue and synthetic tissue glues on the spinal cord: are they safe to use?

“…Other clinical studies have suggested an increased risk of wound infections when BioGlue® is used as dural sealant in cranial surgery, due to a pyogenic and chronic inflammatory response. [25][26][27] Adherus® is an activated PEG and polyethyleneimine hydrogel. PEG hydrogels have been frequently used in medical implants due to their ease of use and potential cytocompatibility.…”