Polyethylene glycol (PEG) hydrogel dural sealant and collagen dural graft matrix in transsphenoidal pituitary surgery for prevention of postoperative cerebrospinal fluid leaks

Burkett, Clinton J.; Patel, Samip; Tabor, M.; Padhya, Tapan; Vale, Fernando Ĺ.

doi:10.1016/j.jocn.2011.04.005

Cited by 34 publications

(33 citation statements)

References 33 publications

(41 reference statements)

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“…PEG hydrogel dural sealant was approved by the Food and Drug Administration for cranial use in April 2005 in the United States, 17) but has been available for clinical use in Japan only since April 2010. The sealant is widely, safely, and effectively used in various neurosurgical fields such as general craniotomy, 6) posterior fossa reconstruction, 17) spinal surgery, 10) pituitary surgery, 3) and in combina- tion with nonautologous dural plasty materials. 22) The clinical efficacy of PEG hydrogel dural sealant has been reported to be 100% for the prevention of intraoperative CSF leakage during surgery with the Valsalva maneuver.…”

Section: Discussionmentioning

confidence: 99%

Simple Solution for Preventing Cerebrospinal Fluid Loss and Brain Shift During Multitrack Deep Brain Stimulation Surgery in the Semisupine Position: Polyethylene Glycol Hydrogel Dural Sealant Capping

Takumi

Mishina

Hironaka

et al. 2013

Neurol. Med. Chir.(Tokyo)

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This study evaluated preliminary findings on the efficacy of polyethylene glycol (PEG) hydrogel dural sealant capping for the prevention of cerebrospinal fluid (CSF) leakage and pneumocephalus during deep brain stimulation (DBS) surgery in the semisupine position. Group A consisted of 5 patients who underwent bilateral subthalamic nucleus (STN)-DBS surgery without PEG hydrogel dural sealant capping. Group B consisted of 5 patients who underwent bilateral STN-DBS surgery with PEG hydrogel dural sealant capping. The immediate postoperative intracranial air volume was measured in all patients and compared between the 2 groups using the Welch test. Adverse effects were also examined in both groups. The intracranial air volume in Group A was 32.3 ± 12.3 ml (range 19.1-42.5 ml), whereas that in Group B was 1.3 ± 1.5 ml (range 0.0-3.5 ml), showing a significant difference (p < 0.005). No hemorrhage or venous air embolisms were observed in either group. The effect of brain shift was discriminated by STN recordings in Group B. These preliminary findings indicate that PEG hydrogel dural sealant capping may reduce adverse effects related to CSF leakage and brain shift during DBS surgery.

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Section: Discussionmentioning

confidence: 99%

Simple Solution for Preventing Cerebrospinal Fluid Loss and Brain Shift During Multitrack Deep Brain Stimulation Surgery in the Semisupine Position: Polyethylene Glycol Hydrogel Dural Sealant Capping

Takumi

Mishina

Hironaka

et al. 2013

Neurol. Med. Chir.(Tokyo)

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“…The safety and efficacy of dural reconstruction with synthetic collagen-based dural substitutes are well described. 7,25,28,36 The structure of the synthetic collagenbased dural substitute presents a low-pressure surface for CSF absorption, promoting a graft-dura interface and chemical signaling for native fibroblasts providing mechanical scaffolding. 28 Litvack et al 25 reported a CSF leakage rate of 6.7%, as well as a 4.2% postoperative infection rate, when using collagen-based substitutes in 425 consecutive patients.…”

Section: Repair Materialsmentioning

confidence: 99%

Repair of middle fossa cerebrospinal fluid leaks using a novel combination of materials: technical note

Shorter¹,

Connor²,

Thakur³

et al. 2012

FOC

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Object Methods for repairing middle fossa CSF (MFCSF) leaks have varied and yielded mixed results. The objective of this study was to evaluate the safety and durability of the authors' repair technique using a novel combination of 3 synthetic materials. Methods The authors performed a retrospective case review of patients treated for CSF leaks between January 2009 and September 2011. Eight patients were found to have undergone middle fossa craniotomies for CSF leaks. Inclusion criteria for the study included age greater than 18 years, neuroimaging-documented temporal bone defect, and symptoms consistent with CSF leaks or gross CSF otorrhea. Seven patients, 3 men and 4 women, met the inclusion criteria, and their charts were reviewed. Hydroxyapatite cement, collagen-based dural substitute matrix, and polyethylene glycol hydrogel sealant were used in all patients for the repair. Results In all patients the MFCSF leaks were successfully repaired. Initial presenting symptoms included CSF otorrhea in 4 patients (57.1%), hearing loss in 3 (42.9%), and CSF rhinorrhea in 1 (14.3%). The mean follow-up duration was 12 months (range 5–33 months). In 1 patient an epidural hematoma developed at the operative site on postoperative Day 2, and in another patient a superficial wound dehiscence occurred on postoperative Day 48. During the follow-up period, the authors found no evidence of wound infections, neurovascular damage, or CSF leakage requiring reoperation. Conclusions The middle fossa approach involving a combination of hydroxyapatite cement, collagen-based dural substitute matrix, and polyethylene glycol hydrogel sealant is a safe, effective method for repairing MFCSF leaks. The combination of synthetic materials provides an alternative to existing materials for skull base surgeons.

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“…6,8,9 A wide variety of materials have been used to restore the barrier between CSF and the sphenoid sinus, including fat, bone, cartilage, fascia lata, gelatin foam, polyester-silicone, polyethylene glycol, Vicryl patch (Ethicon, Somerville, New Jersey, USA), lyophilized dura, fibrin glue, cement, collagen fleece, muscle, cellulose, acellular dermal matrix, and mucosal flaps. 8,[10][11][12][13][14][15][16][17][18] No prospective clinical trials comparing these materials exist; however, fat autograft remains as a gold standard to which new materials must be compared. The present series seeks to compare the use of fat graft sella repair and obliteration of the sphenoid sinus, with pie-crust closure using AlloDerm (LifeCell Corp, Woodlands, Keywords ► pituitary adenoma ► acellular dermal matrix ► AlloDerm ► fat autograft ► cerebrospinal fluid leak ► transsphenoidal surgery…”

Section: Introductionmentioning

confidence: 99%

Acellular Dermal Allograft for Sellar Repair after Transsphenoidal Approach to Pituitary Adenomas

et al. 2013

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Objectives Our practice has transitioned from using fat autograft to acellular dermal matrix (AlloDerm, LifeCell Corp, Woodlands, Texas, USA). We present the largest series to our knowledge of AlloDerm for sellar floor repair after transsphenoidal approach to pituitary adenoma and compare rates of postoperative cerebrospinal fluid (CSF) leak with an earlier cohort of patients whose CSF leaks were repaired with fat autograft. Design This is a retrospective cohort study comparing sellar repair with fat autograft versus inlay Alloderm between the years 2003 and 2012. The primary end point was postoperative CSF leak. Results A total of 429 patients (368 primary; 83 revision operations) without intraoperative lumbar drainage were included. A total of 18 postoperative CSF leaks were observed (3.9%). Intraoperative CSF leak occurred in 160 cases (35.5%). Among this subset of patients with intraoperative CSF leak, 95 underwent repair with AlloDerm and 46 underwent repair with fat autograft, with postoperative CSF leak rates of 8.4% and 15.2%, respectively (p = 0.34, chi-square test); 19 patients underwent repair with other techniques or no repair at all, with postoperative leak rate of 0%. Conclusions AlloDerm is an effective alternative to fat autograft in cases of low-flow CSF leak following transsphenoidal resection of pituitary adenoma.

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Polyethylene glycol (PEG) hydrogel dural sealant and collagen dural graft matrix in transsphenoidal pituitary surgery for prevention of postoperative cerebrospinal fluid leaks

Cited by 34 publications

References 33 publications

Simple Solution for Preventing Cerebrospinal Fluid Loss and Brain Shift During Multitrack Deep Brain Stimulation Surgery in the Semisupine Position: Polyethylene Glycol Hydrogel Dural Sealant Capping

Simple Solution for Preventing Cerebrospinal Fluid Loss and Brain Shift During Multitrack Deep Brain Stimulation Surgery in the Semisupine Position: Polyethylene Glycol Hydrogel Dural Sealant Capping

Repair of middle fossa cerebrospinal fluid leaks using a novel combination of materials: technical note

Acellular Dermal Allograft for Sellar Repair after Transsphenoidal Approach to Pituitary Adenomas

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