DuraSeal Magnetic Resonance and Computed Tomography Imaging: Evaluation in a Canine Craniotomy Model

Kacher, Daniel F.; Frerichs, Kai U.; Pettit, Jeffrey; Campbell, Patrick; Meunch, Tim; Norbash, Alexander

doi:10.1227/01.neu.0000193518.71825.d7

Cited by 22 publications

(27 citation statements)

References 18 publications

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“…However, one of the drawbacks of using DuraSeal TM is its potential to swell up to 50% and its slow resorption rate. The peak expansion of DuraSeal TM was between 3 and 14 days postapplication in a dog model with complete resorption at 8 weeks [6,10]. Owing to these findings, we believe the application of DuraSeal TM in a confined bony area is contraindicated as a result of the concern of swelling and nerve root compression (DuraSeal TM product information.…”

Section: Discussionmentioning

confidence: 95%

Cauda Equina Syndrome After a TLIF Resulting From Postoperative Expansion of a Hydrogel Dural Sealant

Neuman

Radcliff

Rihn

2012

Clinical Orthopaedics &Amp; Related Research

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Background DuraSeal TM (Coviden, Waltham, MA, USA), a hydrogel sealant, is primarily used as an adjunct to a dural repair. Its use has also been described to seal off an annulotomy after a transforaminal lumbar interbody fusion when recombinant human bone morphogenetic protein-2 (rhBMP-2) is used. This aids in the reduction of postoperative radiculitis caused by rhBMP-2. However, as a result of its hydrophilic properties, DuraSeal TM has the potential to swell, which could lead to compression of the thecal sac. Case Description We report a 57-year-old woman who developed cauda equina after a transforaminal lumbar 47 interbody fusion (TLIF) procedure in which the expansion of the DuraSeal TM was believed to be the causative factor. The patient developed urinary retention, bowel incontinence, and paresthesias in the saddle region on postoperative Day 3. She underwent emergent exploration and decompression of the thecal sac. The gel-like DuraSeal TM material was causing significant compression of the thecal sac. Literature Review Multiple reports have documented that DuraSeal TM , used as an adjunct to dural repair, can swell leading to compression of the spinal cord and/or neural elements. Our case demonstrates the use of DuraSeal TM both over a site of a dural repair and over an annulotomy site, through which a TLIF was performed, is associated with the risk of developing postoperative cauda equina syndrome as a result of swelling of the DuraSeal TM . Clinical Relevance Those using DuraSeal TM to seal off the annulotomy after a TLIF procedure performed with rhBMP-2 should use the product with an understanding of the potential postoperative swelling of the product and resulting neurologic sequela, particularly if DuraSeal TM is used concomitantly at the site of dural repair.

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Section: Discussionmentioning

confidence: 95%

Cauda Equina Syndrome After a TLIF Resulting From Postoperative Expansion of a Hydrogel Dural Sealant

Neuman

Radcliff

Rihn

2012

Clinical Orthopaedics &Amp; Related Research

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“…8 Both fibrin glue and PEGH have a high water content and thus have characteristics similar to CSF or reactive inflammation on MR imaging. 9 Furthermore, they are applied over the dural repair, exactly where a postoperative CSF collection or infection may be expected to form. In patients treated with fibrin glue or PEGH, MR images obtained within the first few weeks of surgery to assess postoperative pseudomeningocele are difficult to interpret.…”

mentioning

confidence: 99%

“…One study has examined the radiographic appearance of PEGH in a canine model 9 ; however, to our knowledge, there is no existing comparison of MR imaging appearance in patients in the immediate postoperative timeframe. The analysis will seek to describe the signal characteristics of these 3 sealants under MR imaging and to establish criteria for distinguishing appropriately placed dural sealants from pseudomeningocele.…”

mentioning

confidence: 99%

The Appearance of Dural Sealants under MR Imaging

Tarapore

Mukherjee

Mummaneni

et al. 2012

AJNR Am J Neuroradiol

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SUMMARY:Dural sealants are an adjunct to obtain watertight closure after intradural procedures. This study aims to characterize the appearance on MR imaging of 3 commonly employed dural sealants: fibrin glue, PEGH, and BSAG. To this end, patients who underwent spinal intradural procedures that included the use of dural sealant during closure were identified retrospectively. Post-operative data on 15 patients, including complications such as pseudomeningocele formation and infection, were gathered. The appearance of dural sealants on follow-up MR imaging scans within 3 days of surgery was analyzed. Fifteen patients were identified (5 with fibrin glue, 5 with PEGH, and 5 with BSAG applied during closure) with appropriately timed post-operative MR imaging scans. All 3 substances were identifiable based on anatomic location and imaging characteristics on post-operative MR imaging in standard T1, T1 PGFS, and T2 FSE. Definite differentiation between CSF and fibrin glue or PEGH was not possible with the T1 or T1 PGFS, or with the T2 FSE. Differences in intensity between CSF and BSAG were also not significant on either T1 sequence, but they were statistically significant on the T2 FSE. All patients had an uneventful post-operative course, and no patients developed post-operative pseudomeningocele at 30 days. This study concludes that water-based dural sealants such as fibrin glue and PEGH are difficult to differentiate from CSF on standard T1, T1 PGFS and T2 FSE, while BSAG is easily recognized on the T2 FSE. Recognition of water-based sealants therefore requires communication between the neurosurgeon and the neuroradiologist to avoid post-operative misidentification.ABBREVIATIONS: BSAG ϭ bovine serum albumin and gluteraldehyde polymer; FSE ϭ fast spinecho; PEGH ϭ polyethylene glycol hydrogel; PGFS ϭ postgadolinium fat saturation W atertight closure of the dura is a primary concern in the management of intradural spine tumors. Although Harvey Cushing asserted that "an accurate approximation of the dura in its two layers is desirable," 1 in the modern era, a single-layered dural closure with suture is the standard of care. To further reduce the chance of leakage, numerous adjunctive dural sealants have emerged in the last several years. By being applied to the suture line following primary repair, these substances are designed to bond with the tissue and fill small gaps in the closure, thus preventing leakage of CSF through the repair site. 2,3Three such substances are commonly used in our practice. Fibrin glue (TISSEEL; Baxter BioSurgery, Deerfield, Illinois) has been used as a dural sealant in both cranial and spinal cases. It relies on a solution of fibrinogen, aprotinin, and clotting factors. When mixed with a thrombin counterpart, the fibrin cross-links, causing coagulation and binding to surrounding tissues. The glue is subsequently degraded by natural fibrinolysis during several weeks. Hydrogel (DuraSeal; Covidien, Dublin, Ireland) is a compound based on polyethylene glycol and trilysine, a small amino acid. When...

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“…8,9 In a dog model, DuraSeal's volume expansion was reported to peak between day 3 and 2 weeks after implantation. 10 No quantification of volume expansion is made after application of a 3-mm layer on the intracranial dural surface, but cortical displacement due to the mass effect is noted. Complete absorption of the hydrogel was noted by week 10.…”

Section: Discussionmentioning

confidence: 99%

“…Complete absorption of the hydrogel was noted by week 10. 10 In human intracranial use of DuraSeal, Cosgrove et al reported 75.4% reduction in the thickness of the sealant by 3 months. 11 Blackburn reports a case of cervicomedullary compression after the use of DuraSeal in the repair of the dura overlying the posterior fossa.…”

Section: Discussionmentioning

confidence: 99%

Cauda Equina Compression by Hydrogel Dural Sealant After a Laminotomy and Discectomy

Mulder

Crosier

Dunn

2009

Spine

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DuraSeal Magnetic Resonance and Computed Tomography Imaging: Evaluation in a Canine Craniotomy Model

Cited by 22 publications

References 18 publications

Cauda Equina Syndrome After a TLIF Resulting From Postoperative Expansion of a Hydrogel Dural Sealant

Cauda Equina Syndrome After a TLIF Resulting From Postoperative Expansion of a Hydrogel Dural Sealant

The Appearance of Dural Sealants under MR Imaging

Cauda Equina Compression by Hydrogel Dural Sealant After a Laminotomy and Discectomy

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