Comparison of Small Intestinal Submucosal Graft and Autologous Tissue in Prevention of CSF leak after Posterior Fossa Craniotomy

Abstract

Objective To compare the use of porcine small intestinal submucosal grafts (SISG) and standard autologous material (fascia) in prevention of cerebrospinal fluid (CSF) leak and pseudomeningocele formation after translabyrinthine resection. Setting Set at the tertiary skull base center. Methods This is a retrospective chart review. After Institutional Review Board approval, we performed a retrospective cohort study evaluating CSF leak in patients who underwent resection of lateral skull base defects with multilayered reconstruction using either fascia autograft or porcine SISGs. Demographics were summarized with descriptive statistics. Logistic regression was used to compare autograft and xenograft cohorts in terms of CSF complications. Results Seventy-seven patients underwent lateral skull base resection, followed by reconstruction of the posterior cranial fossa. Of these patients, 21 (27.3%) underwent multilayer repair using SISG xenograft. There were no significant differences in leak-associated complications between autograft and xenograft cohorts. Ventriculoperitoneal shunt was necessary in one (1.8%) autograft and one (4.8) xenograft cases (p = 0.49). Operative repair to revise surgical defect was necessary in three (5.4%) autograft cases and none in xenograft cases. Conclusion The use of SISG as a component of complex skull base reconstruction after translabyrinthine tumor resection may help reduce CSF leak rates and need for further intervention.

Clinical outcomes of a novel porcine small intestinal submucosa patch for full-thickness hand skin defects: a retrospective investigation

“…The ideal artificial skin coverage should be easy to obtain, convenient to use, bioactive, and protective. Since SIS patch has been used more than 3 decades in the field of medicine, it has been shown to help tissue regeneration and angiogenesis, such as in skull base reconstruction [ 22 , 23 ], upper airway tissue remodeling [ 24 ], tympanic membrane repair [ 25 ], cardiovascular diseases [ 26 ]. The natural three-dimensional ECM framework composed of collagen I, III, and IV and a variety of bioactive substances it contains makes it helpful during wound healing [ 7 , 8 ], and this kind of particular composition enables it rapid the rate of angiogenesis and does not activate immune system [ 9 , 10 ].…”

“…F Appearance of the affected hand during the last time follow-up, and texture mismatch and scar hyperplasia could be observed. The result of the SCAR scale was 8 and the sensation of the newborn skin was S3 according to the BMRC grading system Zang et al Journal of Orthopaedic Surgery and Research (2023) 18:50 in the field of medicine, it has been shown to help tissue regeneration and angiogenesis, such as in skull base reconstruction [22,23], upper airway tissue remodeling [24], tympanic membrane repair [25], cardiovascular diseases [26]. The natural three-dimensional ECM framework composed of collagen I, III, and IV and a variety of bioactive substances it contains makes it helpful during wound healing [7,8], and this kind of particular composition enables it rapid the rate of angiogenesis and does not activate immune system [9,10].…”

Skull Base Repair following Resection of Vestibular Schwannoma: A Systematic Review (Part 2: The Translabyrinthine Approach)

“…Several studies reported an onlay technique to seal the dura, employing autologous grafts, xenografts and synthetic dural substitutes. 17,21,22,25,42,[47][48][49][50] Autologous onlays consisted of fascia grafts, harvested either from the abdomen or thigh. 17,22,25,42,48,51 Variations in the autologous onlay technique centred around the size of the graft used, ranging from slightly larger than the dural defect to a 'peri cranial graft basket' 47 .…”

“…17,21,22,25,42,[47][48][49][50] Autologous onlays consisted of fascia grafts, harvested either from the abdomen or thigh. 17,22,25,42,48,51 Variations in the autologous onlay technique centred around the size of the graft used, ranging from slightly larger than the dural defect to a 'peri cranial graft basket' 47 . Advantages of autologous grafts include their cost profile, universal availability, and high compatibility with the local tissue environment, while drawbacks include donor site-related complications and increased operative times.…”

“…Synthetic onlays avoid graft site complications associated with autografts and are resorbable, quickly providing an effective seal.). 25,[48][49][50] Synthetic onlays avoid graft site complications associated with autografts and are resorbable, quickly providing an effective seal. One ineffective synthetic onlay was that described by Arriaga et al 21 , consisting of a hardened patty of hydroxyapatite cement, which was associated with higher CSF leak rates in the first 7 patients (28.5%) and was hence discontinued for their remaining cohort.…”