Hemopatch® with fibrin glue as a dural sealant in cranial and spinal surgery. A technical note with a review of the literature

Montano, Nicola; Giordano, Martina; Caccavella, Valerio Maria; Ioannoni, Eleonora; Polli, Filippo Maria; Papacci, Fabio; Olivi, Alessandro

doi:10.1016/j.jocn.2020.07.011

Cited by 14 publications

(18 citation statements)

References 14 publications

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“…Patients submitted to craniectomy and patients who underwent a second surgery showed an higher CSF leak rate. Ongoing improvement of biomaterial technology [19] may help neurosurgeons to prevent this potentially life-threatening complication.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with cerebrospinal fluid leak after a retrosigmoid approach for cerebellopontine angle surgery

Montano

Signorelli

Giordano

et al. 2021

Surgical Neurology International

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Background: The retrosigmoid approach represents a crucial surgical route to address different lesions in the cerebellopontine angle but cerebrospinal fluid (CSF) leak still remains the most frequent complication after this approach. Here, we analyzed the impact of different factors in CSF leak development after a retrosigmoid approach. Identifying risk factors related to a specific approach may help the surgeon to tailor the perioperative management and to appropriately counsel patients regarding their risk profile. Methods: We retrospectively reviewed the clinical, surgical, and outcome data of 103 consecutive patients (M/F, 47/56; mean follow-up 35.6 ± 23.9 months) who underwent a retrosigmoid approach for different cerebellopontine angle pathologies and studied the impact of different factors on the occurrence of a CSF leak to univariate and multivariate analysis. Results: Seventy-nine patients (76.7%) were operated for tumors growing in the cerebellopontine angle. Twenty-four patients (23.2%) underwent microvascular decompression to treat a drug-resistant trigeminal neuralgia. Sixteen patients (15.5%) developed CSF leak in the postoperative course of which six underwent surgical revision. Performing a craniectomy as surgical procedure (P = 0.0450) and performing a reopening procedure (second surgery; P = 0.0079) were significantly associated to a higher risk of developing CSF leak. Moreover, performing a reopening procedure emerged as an independent factor for CSF developing on multivariate analysis (P = 0.0156). Conclusion: Patients submitted to craniectomy and patients who underwent a second surgery showed an higher CSF leak rate. Ongoing improvement of biomaterial technology may help neurosurgeons to prevent this potentially life-threatening complication.

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Section: Discussionmentioning

confidence: 99%

Factors associated with cerebrospinal fluid leak after a retrosigmoid approach for cerebellopontine angle surgery

Montano

Signorelli

Giordano

et al. 2021

Surgical Neurology International

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“…Moreover, they confirmed the effectiveness of fibrin glue for microvascular decompression, rhizotomy, laminectomy (removal of spinous processes and vertebral arches) and tumor craniotomy. The outcome of studies on rat models demonstrated that neurotrophic factor-embedded fibrin glue can successfully be used for targeted therapy [9,43].…”

Section: Other Applications Of Fibrin Gluementioning

confidence: 99%

Fibrin glues — the current state of knowledge

Goczyńska

Lasocka

Lachert

2021

Journal of Transfusion Medicine

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“…Cerebrospinal fluid (CSF) leakage is a relevant complication in cranial and spinal interventions, increasing the risk of infections and the duration of hospital stays [1]. In cranial procedures, CSF leaks have been reported at rates from 0.9 to 34.6% [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…In cranial procedures, CSF leaks have been reported at rates from 0.9 to 34.6% [2][3][4][5][6][7]. In spinal surgery, CSF leakage rates from 0 to 11.7% have been observed [1,8,9]. In addition to traditional neurosurgical techniques, hemostatic patches such as Hemopatch ® can be helpful tools to achieve watertight closure of the dura mater in order to prevent leakage of CSF into the surrounding tissue [4,10].…”

Section: Introductionmentioning

confidence: 99%

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Real-World Data on the Usage of Hemopatch® as a Hemostat and Dural Sealant in Cranial and Spinal Neurosurgery

Schebesch¹,

Hrbac²,

Jančálek³

et al. 2023

Cureus

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Background and objectivesCerebrospinal fluid (CSF) leakage is a significant complication in cranial and spinal interventions.Hemostatic patches such as Hemopatch ® are therefore used to support the watertight closure of the dura mater. Recently, we published the results of a large registry documenting the effectiveness and safety of Hemopatch ® in various surgical specialties, including neurosurgery. Here we aimed to analyze the outcomes from the neurological/spinal cohort of this registry in more detail. MethodsBased on the data from the original registry, we performed a post hoc analysis for the neurological/spinal cohort. The Hemopatch ® registry was designed as a prospective, multicenter, single-arm observational study. All surgeons were familiar with the application of Hemopatch ® and it was used at the discretion of the responsible surgeon. The neurological/spinal cohort was open for patients of any age if they had received Hemopatch ® during an open or minimally invasive cranial or spinal procedure. Patients with known hypersensitivity to bovine proteins or brilliant blue, intraoperative pulsatile severe bleeding, or an active infection at the potential target application site (TAS) were excluded from the registry. For the posthoc evaluation, we stratified the patients of the neurological/spinal cohort into two sub-cohorts: cranial and spinal. We collected information about the TAS, intraoperative achievement of watertight closure of the dura, and occurrence of postoperative CSF leaks. ResultsThe registry comprised 148 patients in the neurological/spinal cohort when enrolment was stopped. The dura was the application site for Hemopatch ® in 147 patients (in one patient in the sacral region after tumor excision), of which 123 underwent a cranial procedure. Twenty-four patients underwent a spinal procedure. Intraoperatively, watertight closure was achieved in 130 patients (cranial sub-cohort: 119; spinal subcohort: 11). Postoperative CSF leakage occurred in 11 patients (cranial sub-cohort: nine; spinal sub-cohort: two). We observed no serious adverse events related to Hemopatch ® . ConclusionOur post hoc analysis of real-world data from a European registry confirms the safe and effective use of Hemopatch ® in neurosurgery, including cranial and spinal procedures, as also observed in some case series.

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Hemopatch® with fibrin glue as a dural sealant in cranial and spinal surgery. A technical note with a review of the literature

Cited by 14 publications

References 14 publications

Factors associated with cerebrospinal fluid leak after a retrosigmoid approach for cerebellopontine angle surgery

Factors associated with cerebrospinal fluid leak after a retrosigmoid approach for cerebellopontine angle surgery

Fibrin glues — the current state of knowledge

Real-World Data on the Usage of Hemopatch® as a Hemostat and Dural Sealant in Cranial and Spinal Neurosurgery

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