Delayed Cerebrospinal Fluid Leak after Watertight Dural Closure with a Polyethylene Glycol Hydrogel Dural Sealant in Posterior Fossa Surgery: Case Report

Abstract

A polyethylene glycol (PEG) hydrogel sealant recently has been approved as an adjunct to sutured dural closure in Japan. We treated consecutive six patients with PEG hydrogel sealant in posterior fossa operation. Three of six cases suffered delayed cerebrospinal fl uid (CSF) leak after watertight dural closure with the PEG hydrogel sealant, although there was no leak case which was treated with fi brin glue, before 2 years until the adoption of the new material. These patients underwent posterior fossa craniotomy and discharged without remarkable CSF leak. The pseudomeningocele under the occipital wound caused the CSF leak occurr from 5th to 7th week postoperatively. All CSF leak cases needed surgical repair. At the repair, the PEG hydrogel was liquefi ed and almost absorbed. A fi stula on the closure line and a dead space after the absorption of the PEG hydrogel was observed. When the absorbable PEG hydrogel sealant plugs in small gaps of sutured dura, its properties to prevent adhesion might suppress healing process of dural closure, so that CSF could leak through the gaps and collect as a pseudomeningocele in the dead space after absorption of the PEG hydrogel. In posterior fossa surgery a PEG hydrogel sealant should be applied when dural edges are closed tightly without any gaps.

Large retrospective study of artificial dura substitute in patients with traumatic brain injury undergo decompressive craniectomy

“…Allograft of dura is very limited due to the availability of the donor. Biosynthesized materials have been widely used in dura repair, including collagen film (Wang et al., ), silk fibroin (Kim et al., ), polyethylene glycol hydrogel (Jito, Nitta, & Nozaki, ; Osbun et al., ; Than, Baird, & Olivi, ), and ePTFE (Matsumoto et al., ; Wang et al., ; Yamagata, Goto, Oda, & Kikuchi, ), not only in TBI, also in other neurosurgeries, such as tumor dissection. However certain complications were associated with these biosynthesized materials.…”

Late presentation of dural tears: Two case reports and review of literature

“…Sneezing, coughing, and other factors increase abdominal pressure, which in turn affects CSF pressure. In addition, obvious cavities after spinal surgery may lead to a lack of supporting structures behind the dura, which will affect the pressure balance between the inner and outer dura, and finally show an increase in the local CSF pressure in the cavity[ 19 - 21 ].…”

The histopathological effects of reabsorbable polyethylene glycol hydrogel (Coseal) on epidural fibrosis in an experimental postlaminectomy model in rats

“…Despite these successful results in vascular surgery, it was not as effective as fibrin glue in adhering to the kidney surface and preventing urine leakage in the experimental model of laparoscopic partial nephrectomy [41]. DuraSeal (Covidien, USA) is used against cerebrospinal fluid fistulas in addition to standard dural repair methods and as an adhesion barrier to prevent postoperative EF [42][43][44]. However, side effects such as wound infection, kidney damage, foreign body reaction, neurological problems, and allergic reactions have been reported [30].…”