Failure pressures after repairs of 2-cm × 2.5-cm rhinologic dural defects in a porcine ex vivo model

Lin, Ryan P.; Weitzel, Erik K; Chen, Philip G.; McMains, Kevin C.; Chang, Daniel R.; Braxton, Ernest E.; Majors, Jacob; Bunegin, Leonid

doi:10.1002/alr.21804

Cited by 3 publications

(8 citation statements)

References 19 publications

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“…Consistent with our previous work, 18,19 the No Additional Support repair mean failure pressure of 6.494 ± 2.553 mm Hg demonstrated an inability to maintain a hermetic seal at the lower limits of normal physiologic ICP. Interestingly, the Direct Support repair with the FBC withstood an even lower average pressure of 5.103 ± 3.913 mm Hg, with a wider variation of tolerated pressures.…”

Section: Discussionsupporting

confidence: 89%

“…33 Despite these cohort studies, there have been no controlled studies that identify the effect of packing on the strength of skull base repairs. The authors’ previous work in an ex vivo model suggested that most unsupported repairs of small (5 mm) 18 and large (2.5 cm) 19 cranial base defects are unable to withstand elevated intracranial pressures; therefore, it is arguably beneficial to perform ancillary measures to acutely bolster the repair as it heals.…”

Section: Discussionmentioning

confidence: 99%

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Augmentation of Dural Defect Repairs Strength With an Acrylic Plate in a Porcine Ex Vivo Model

Chen

Clampitt

Chorath

et al. 2019

Am J Rhinol�Allergy

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Background Large skull base defects can be challenging to repair. This study uses a controlled ex vivo model to examine the failure pressures of various dural repairs of large skull base defects using mucosa with fibrin glue under 3 conditions: No Additional Support of the repair, support with a Foley catheter (Direct Support), and with Foley catheter contact over a rigid acrylic plate (Diffuse Support). Methods Failure pressures of dural repairs with and without support were determined in a porcine model using an ex vivo closed testing apparatus. In addition, 20 mm × 15 mm dural defects were created. Skull base repairs were performed using porcine dura as an underlay graft followed by a septal mucosa overlay. Saline was infused at 30 mL/h, applying even force to the underside of the graft until repair failure occurred for each condition (none, direct, and diffuse support). Five trials were performed per repair type for a total of 15 repairs. Results The mean failure pressures were as follows: No Additional Support, 6.494 ± 2.553 mm Hg; Direct Support, 5.103 ± 3.913 mm Hg; and Diffuse Support, 15.649 ± 2.638 mm Hg. A post hoc Bonferroni-Holm test demonstrated significant difference between No Additional Support and Diffuse Support ( P = .001), as well as Direct Support and Diffuse Support ( P = .002). Conclusion Support of dural repairs in this model withstood higher pressures when the Foley catheter’s support is distributed evenly using a flat acrylic plate. Use of this plate is the only repair tested in this model that tolerated normal adult supine intracranial pressures.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Augmentation of Dural Defect Repairs Strength With an Acrylic Plate in a Porcine Ex Vivo Model

Chen

Clampitt

Chorath

et al. 2019

Am J Rhinol�Allergy

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“…Previous work reported that collagen matrix and fibrin glue performed better than nonglue repairs in an ex vivo model. 5…”

Section: Discussionmentioning

confidence: 99%

“…The test design was a modification of an apparatus used in a previous study. 5,7 The device was fabricated from 2 00 polyvinyl chloride (PVC) piping as depicted in Figure 1. A small hole was drilled on the side of the end cap, with a 3-way stop cock used to infuse saline solution and monitor chamber pressure, simulating increasing ICP.…”

Section: Testing Apparatusmentioning

confidence: 99%

“…4 A previous study in an ex vivo model suggested that a combination of collagen matrix underlay with fibrin glue created a more effective seal than other tested repair methods when used in a simulated CSF leak repair model. 5 However, the findings suggested that even the most robust repair tested could not withstand physiologic causes of increased intracranial pressure (ICP) such as straining or sneezing. Therefore, it is important to develop more robust methods of reconstructing the skull base and preventing CSF leaks after surgery.…”

Section: Introductionmentioning

confidence: 99%

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Failure Pressures of Dural Repairs in a Porcine Ex Vivo Model: Novel Use of Titanium Clips Versus Tissue Glue

Chorath

Krysinski

Bunegin

et al. 2019

Allergy�Rhinol (Providence)

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ObjectiveEndoscopic skull base surgery is advancing, and it is important to have reliable methods to repair the resulting defect. The objective of this study was to determine the failure pressures of 2 commonly used methods to repair large dural defects: collagen matrix underlay with fibrin glue and collagen matrix underlay with polyethylene glue, as well as a novel repair method: fascia lata with nonpenetrating titanium vascular clips.MethodsThe failure pressure of the 3 dural repairs was determined in a closed testing apparatus. Defects in porcine dura were created and collagen matrix grafts were used as an underlay followed by either fibrin glue (FG/CMG) or polyethylene glycol glue (PEG/CMG). A third condition using a segment of fascia lata was positioned flush with the edges of the dural defect and secured with titanium clips (TC/FL). Saline was infused to simulate increasing intracranial pressure (ICP) applied to the undersurface of the grafts until the repairs failed.ResultsThe mean failure pressure of the PEG/CMG repair was 34.506 ± 14.822 cm H2O, FG/CMG was 12.413 ± 5.114 cm H2O, and TC/FL was 8.330 ± 3.483 cm H2O. There were statistically significant differences in mean failure pressures among the 3 repair methods.ConclusionIn this ex vivo model comparing skull base repairs’ ability to withstand cerebrospinal fluid leak, the repairs that utilized PEG/CMG tolerated the greatest amount of pressure and was the only repair that exceeded normal physiologic ICP’s. Repair methods utilizing glues generally tolerated higher pressures compared to the novel repair using clips alone.

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Emerging Developments in Skull Base Reconstruction

Goshtasbi

Tajudeen

Lin

et al. 2023

Skull Base Reconstruction

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Failure pressures after repairs of 2-cm × 2.5-cm rhinologic dural defects in a porcine ex vivo model

Abstract: All glued repairs performed better than non-glued repairs. Both D/T and FL/T repairs performed better than B/T repairs. No repair tolerated pressures throughout the full range of adult supine intracranial pressure.

Cited by 3 publications

References 19 publications

Augmentation of Dural Defect Repairs Strength With an Acrylic Plate in a Porcine Ex Vivo Model

Augmentation of Dural Defect Repairs Strength With an Acrylic Plate in a Porcine Ex Vivo Model

Failure Pressures of Dural Repairs in a Porcine Ex Vivo Model: Novel Use of Titanium Clips Versus Tissue Glue

Emerging Developments in Skull Base Reconstruction

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