Effectiveness of Sealants in Prevention of Cerebrospinal Fluid Leakage after Spine Surgery: A Systematic Review

Kinaci, Ahmet; Moayeri, Nizar; Zwan, Albert van der; Doormaal, Tristan P.C. van

doi:10.1016/j.wneu.2019.02.236

Cited by 30 publications

(32 citation statements)

References 57 publications

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“…Liqoseal, Adherus, Duraseal, Tachosil, and Tisseel Fibrin Sealant (Baxter International, Illinois, USA) were tested (Supplementary Material 2C). Tisseel was included in the spinal model as it is the most commonly used dural sealant in spinal surgery [2]. Tisseel is a hemostatic liquid glue composed of fibrinogen and thrombin that mimics blood clotting [28].…”

Section: Acute Burst Pressure Testmentioning

confidence: 99%

“…Cerebrospinal fluid (CSF) leakage is a potentially severe complication in neurosurgery that occurs in 8.2-13.8% of all cases following intradural surgery or because of an unintended durotomy in extradural spinal surgery [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…Sealants are used to achieve watertight dural closure after primary closure or in combination with dural substitutes [9]. However, recent systematic reviews have shown that clinically used sealants do not reduce the rate of CSF leakage after cranial and spinal surgery [1,2]. An ex vivo model was designed to test the effectiveness of the most clinically used sealants in an objective and standardized manner [10].…”

Section: Introductionmentioning

confidence: 99%

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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: Acute Burst Pressure Testmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Meta‐analyses showed that currently approved sealants seem not to be effective in preventing CSF leakage after cranial and spinal surgery 1,6 . Ex vivo evaluation of these same sealants showed concerning results regarding adhesion strength to dura 7 .…”

Section: Introductionmentioning

confidence: 99%

Safety and biodegradability of a synthetic dural sealant patch (Liqoseal) in a porcine cranial model

Kinaci

Bergmann

Thoor³

et al. 2021

Anim Models and Exp Med

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Background Liqoseal consists of a watertight layer of poly(ester)ether urethane and an adhesive layer containing polyethylene glycol‐N‐hydroxysuccinimide (PEG‐NHS). It is designed to prevent cerebrospinal fluid (CSF) leakage after intradural surgery. This study assessed the safety and biodegradability of Liqoseal in a porcine craniotomy model. Methods In 32 pigs a craniotomy plus durotomy was performed. In 15 pigs Liqoseal was implanted, in 11 control pigs no sealant was implanted and in 6 control pigs a control dural sealant (Duraseal or Tachosil) was implanted. The safety of Liqoseal was evaluated by clinical, MRI and histological assessment. The degradation of Liqoseal was histologically estimated. Results Liqoseal, 2 mm thick before application, did not swell and significantly was at maximum mean thickness of 2.14 (±0.37) mm at one month. The foreign body reaction induced by Liqoseal, Duraseal and Tachosil were comparable. Liqoseal showed no adherence to the arachnoid layer and was completely resorbed between 6 and 12 months postoperatively. In one animal with Liqoseal, an epidural fluid collection containing CSF could not be excluded. Conclusion Liqoseal seems to be safe for intracranial use and is biodegradable. The safety and performance in humans needs to be further assessed in clinical trials.

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“…Iatrogenic durotomy and subsequent CSF leak are not uncommon events during minimally invasive spine surgery [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Direct Pars Defect Tubular Decompression and TLIF for the Treatment of Low-Grade Adult Isthmic Spondylolisthesis: Surgical Challenges and Nuances of a Muscle-Sparing Minimally Invasive Approach

Roberti

Arsenault

2020

Minimally Invasive Surgery

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Effectiveness of Sealants in Prevention of Cerebrospinal Fluid Leakage after Spine Surgery: A Systematic Review

Cited by 30 publications

References 57 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

Safety and biodegradability of a synthetic dural sealant patch (Liqoseal) in a porcine cranial model

Direct Pars Defect Tubular Decompression and TLIF for the Treatment of Low-Grade Adult Isthmic Spondylolisthesis: Surgical Challenges and Nuances of a Muscle-Sparing Minimally Invasive Approach

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