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

Kinaci, Ahmet; Doormaal, Tristan P.C. van

doi:10.1080/17434440.2019.1626232

Cited by 29 publications

(23 citation statements)

References 36 publications

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“…Systematic reviews have shown that CSF leakage still occurs after intradural surgery and that the CSF leakage rate does not decrease with sealant use. However, sealants are assumed to be an important adjunct to create a watertight closure of the dura [33]. Although CSF leakage will most likely never be eliminated in clinical practice, if a durable watertight closure could be achieved, a reduction in the CSF leakage rate would certainly be expected.…”

Section: Discussionmentioning

confidence: 99%

Ex vivo evaluation of a multilayered sealant patch for watertight dural closure: cranial and spinal models

Kinaci

Thoor²,

Redegeld³

et al. 2021

J Mater Sci: Mater Med

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Cerebrospinal fluid leakage is a frequent complication after cranial and spinal surgery. To prevent this complication and seal the dura watertight, we developed Liqoseal, a dural sealant patch comprising a watertight polyesterurethane layer and an adhesive layer consisting of poly(DL-lactide-co-ε-caprolactone) copolymer and multiarmed N-hydroxylsuccinimide functionalized polyethylene glycol. We compared acute burst pressure and resistance to physiological conditions for 72 h of Liqoseal, Adherus, Duraseal, Tachosil, and Tisseel using computer-assisted models and fresh porcine dura. The mean acute burst pressure of Liqoseal in the cranial model (145 ± 39 mmHg) was higher than that of Adherus (87 ± 47 mmHg), Duraseal (51 ± 42 mmHg) and Tachosil (71 ± 16 mmHg). Under physiological conditions, cranial model resistance test results showed that 2 of 3 Liqoseal sealants maintained dural attachment during 72 hours as opposed to 3 of 3 for Adherus and Duraseal and 0 of 3 for Tachosil. The mean burst pressure of Liqoseal in the spinal model (233 ± 81 mmHg) was higher than that of Tachosil (123 ± 63 mmHg) and Tisseel (23 ± 16 mmHg). Under physiological conditions, spinal model resistance test results showed that 2 of 3 Liqoseal sealants maintained dural attachment for 72 hours as opposed to 3 of 3 for Adherus and 0 of 3 for Duraseal and Tachosil. This novel study showed that Liqoseal is capable of achieving a strong watertight seal over a dural defect in ex vivo models.

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Section: Discussionmentioning

confidence: 99%

Ex vivo evaluation of a multilayered sealant patch for watertight dural closure: cranial and spinal models

Kinaci

Thoor²,

Redegeld³

et al. 2021

J Mater Sci: Mater Med

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show abstract

“…[48] This concern about volume swelling is severe in spinal surgery for the confined operation space and delicate neural tissue. [40,49] DuraSeal for dural repair with a swelling ratio higher than 50% has been reported with the complications in inducing spinal cord compression in some cases. [18,19,50,51] Then, a low-swelling formulation (swelling ratio of 19%) was developed, but it was not suggested for use in very confined spaces.…”

Section: Avoiding Compression Injury To the Spinal Cord Using Raas Hy...mentioning

confidence: 99%

An Injectable Rapid‐Adhesion and Anti‐Swelling Adhesive Hydrogel for Hemostasis and Wound Sealing

Bian

Hao

Qiu

et al. 2022

Adv Funct Materials

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Injectable hydrogel adhesives integrating both rapid adhesion to wet tissues and anti‐swelling in humid environments are highly desired for fast hemostasis and wound sealing in surgical applications. Herein, utilizing the synergistic effect of thermo‐sensitive shrinkable nano‐micelle gelators and small molecular adhesive moieties, an injectable hydrogel with rapid‐adhesion and anti‐swelling properties (RAAS hydrogel) is fabricated. The RAAS hydrogel can undergo ultrafast gelation to achieve wet adhesion within 2 s of ultraviolet illumination and exhibit an outstanding anti‐swelling performance with non‐expansion of volume during the whole degradation process. It also presents good biocompatibility and low risk of hemolysis. Its fast hemostasis is demonstrated in diverse hemorrhage models with injuries in the liver, artery, heart, cranial vessel, and brain cortex in small animals. Importantly, its volume stability in humid internal environment can maintain the strong adhesion strength and avoid compression injury to spinal cord when applied for dura sealing. These data suggest that the injectable RAAS hydrogel holds potential for the applications of fast hemostasis and wound sealing with the benefits of stable adhesion and reducing the risk of tissue compression injury.

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“…24,25 Although robust and stable seals of the dura mater are critical for post-neurological surgery, according to systematic reviews and in vitro studies, the currently available dural sealants still lack efficacy. 26,27 Van Doormaal et al reported a comparison analysis of nine common dural sealants using an in vitro model. With a modified ASTM F2392-04 (Standard Test Method for Burst Strength of Surgical Sealants) test methodology, their study quantified the acute burst pressure and a 3-day sustained pressure (16 mmHg) test of a dural repair using an animal model.…”

Section: Endoscopic Endonasal Transsphenoidal Surgery and Complicationsmentioning

confidence: 99%

Electrospinning of cyanoacrylate tissue adhesives for human dural repair in endonasal surgery

et al. 2021

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Cerebral spinal fluid (CSF) leakage is a major postoperative complication requiring surgical intervention, resulting in prolonged healing and higher costs. Biocompatible polymers, such as cyanoacrylates, are currently used as tissue adhesives for closing surgical defects and incisions. Coupling these polymers with nanofiber technology shows promising results for generating nanofibers used in wound care, tissue engineering, and drug delivery. Fiber membranes formed by electrospinning of n-octyl-2-cyanoacrylate (NOCA) are investigated for in situ dural closures after neurosurgery to improve the quality of the closure and prevent post-surgical CSF leaks.Electrospun NOCA fiber membranes showed significantly higher sealing capabilities of defects in human dura, with an average burst pressure of 149 mmHg, compared with that of an FDA-approved common dural sealant that had an average burst pressure of 37 mmHg. In this study, microfabrication of NOCA fibers demonstrates a promising technique for dural repairs.

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

Cited by 29 publications

References 36 publications

Ex vivo evaluation of a multilayered sealant patch for watertight dural closure: cranial and spinal models

Ex vivo evaluation of a multilayered sealant patch for watertight dural closure: cranial and spinal models

An Injectable Rapid‐Adhesion and Anti‐Swelling Adhesive Hydrogel for Hemostasis and Wound Sealing

Electrospinning of cyanoacrylate tissue adhesives for human dural repair in endonasal surgery

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