Pre-clinical subdural tissue reaction and absorption study of absorbable hemostatic devices

Barbolt, Thomas A.; Odin, Marielle; Léger, Michel; Kangas, Lynn

doi:10.1179/016164101101198794

Cited by 39 publications

(28 citation statements)

References 8 publications

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“…The granulation/abscess tissue formation observed in the fibrin glue-treated incisions indicated ongoing biological repair, which was not observed to the same extent on the side sealed with PEG hydrogel. 1,5,6,10,18 No significant abscess formation was found in the fibrin glue-sealed incisions in this study. Adequate blood supply is very important for accelerating wound healing and preventing postoperative infection.…”

Section: Granulation/abscess Formation In the Cerebral Cortex And Cormentioning

confidence: 67%

Comparative study of fibrin and chemical synthetic sealant on dural regeneration and brain damage

Itō¹,

Horiuchi²,

Oyanagi³

et al. 2013

SPI

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Object Several materials, such as polyethylene glycol (PEG) hydrogel and fibrin glue, have been used to seal dural incisions after brain and spinal surgeries. Although the use of PEG sealant is gaining popularity, it can be associated with postoperative cerebrospinal fluid leakage and infection. However, the reasons for this association are currently unknown. The present study aimed to investigate the effects of PEG sealant and fibrin glue on wound healing and brain damage in vivo. Methods Oval-shaped bone defects and dural defects were created bilaterally over the parietal lobes of 22 Japanese white rabbits. The dural defects were covered with 0.5 ml of fibrin glue on one side and 0.5 ml of PEG sealant on the other side. Dural regeneration and brain damage were investigated in each harvested brain and dura mater using light microscopy. Results Dural regeneration was more effective in the presence of fibrin glue than it was with PEG sealant (p = 0.014). Of the 22 rabbits, 11 showed thick (Grades ++ and +++) dural regeneration by 28 days postsurgery in the hemisphere where fibrin glue was used, whereas Grade +++ dural regeneration was not observed in the PEG hydrogel hemisphere, and only 4 rabbits showed Grade ++ regeneration. Abscess and granulation formation also tended to be more severe when PEG hydrogel sealant was used. No Grade ++ granulation/abscess formation was observed with fibrin glue, and Grade + was only observed in 13 of 22 rabbits. Conversely, with PEG hydrogel sealant, only 2 rabbits did not show granulation/abscess formation, and Grade +, ++, and +++ granulation/abscess formation was observed in 8, 7, and 5 rabbits, respectively. The extent of cortical damage was significantly greater in rabbits with abscesses and granulations, compared with rabbits without these lesions (p = 0.007). Conclusions Dural regeneration tended to occur more rapidly with fibrin glue, whereas granulation was more likely with PEG hydrogel sealant, which led to postoperative complications. Histological analysis indicated that PEG hydrogel sealant inhibited the normal tissue healing process and that outcomes were improved by the use of fibrin glue.

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Section: Granulation/abscess Formation In the Cerebral Cortex And Cormentioning

confidence: 67%

Comparative study of fibrin and chemical synthetic sealant on dural regeneration and brain damage

Itō¹,

Horiuchi²,

Oyanagi³

et al. 2013

SPI

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“…In the multi-institutional review 52 , the use of any hemostatic agent was a significant risk factor for developing hydrocephalus in the univariate analysis (but not the multivariate analysis). Avitene has been reported to induce granulomatous inflammatory responses post-craniotomy in both patients and animal models 53, 54 . It is possible that this inflammation poses a risk for hydrocephalus similar to that seen in patients with intraventricular infection or hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Fifty Consecutive Hemispherectomies

Lew¹,

Koop

Mueller³

et al. 2014

Neurosurgery

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Background Techniques for achieving hemispheric disconnection in patients with epilepsy continue to evolve. Objective To review the outcomes of the first 50 hemispherectomy surgeries performed by a single surgeon with an emphasis on outcomes, complications, and how these results led to changes in practice. Methods The first 50 hemispherectomy cases performed by the lead author were identified from a prospectively maintained database. Patient demographics, surgical details, clinical outcomes, and complications were critically reviewed. Results From 2004 to 2012, 50 patients underwent hemispherectomy surgery (mean follow-up time 3.5 years). Modified lateral hemispherotomy (MLH) became the preferred technique and was performed on 44 patients. Forty patients (80%) achieved complete seizure freedom (Engel I). Pre- and post-surgical neuropsychological evaluations demonstrated cognitive stability. Two cases were performed for palliation only. Previous hemispherectomy surgery was associated with worsened seizure outcome (2 of 6 seizure-free, P = .005). The use of Avitene was associated with a higher incidence of postoperative hydrocephalus (56% v. 18%, P = .03). In MLH patients without the use of Avitene, the incidence of hydrocephalus was 13%. Complications included: infection (3), incomplete disconnection requiring reoperation (1), reversible ischemic neurologic deficit (1), and craniosynostosis (1). There were no (unanticipated) permanent neurological deficits or deaths. Minor technique modifications were made in response to specific complications. Conclusion The modified lateral hemispherotomy is effective and safe for both initial and revision hemispherectomy surgery. Avitene use appears to result in a greater incidence of postoperative hydrocephalus.

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“…In the first few weeks after application, fibrin glue causes intense inflammation of vessels, including necrosis, and may cause arterial occlusions (24). Although relatively safe, the inflammatory reaction produced by absorbable gelatin sponge may last several months and may cause foreign body reactions that may be diagnosed as abscess or tumor (4,33).…”

Section: Comparison Of Inflammatory Reactions Induced By Other Materimentioning

confidence: 99%

Toward Optimal Tissue Sealants for Neurosurgery: Use of a Novel Hydrogel Sealant in a Canine Durotomy Repair Model

et al. 2003

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The hydrogel-treated animals exhibited normal progression of dural healing, no dural adhesions, and no underlying effects on the brain. Although dural healing progressed normally, the control animals displayed marked peridural adhesions. The results of this in vivo study suggest that hydrogels, such as that used here, may significantly decrease cerebrospinal fluid leakage, thereby increasing the safety and effectiveness of dural closure in patients and facilitating surgical reexploration.

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Pre-clinical subdural tissue reaction and absorption study of absorbable hemostatic devices

Cited by 39 publications

References 8 publications

Comparative study of fibrin and chemical synthetic sealant on dural regeneration and brain damage

Comparative study of fibrin and chemical synthetic sealant on dural regeneration and brain damage

Fifty Consecutive Hemispherectomies

Toward Optimal Tissue Sealants for Neurosurgery: Use of a Novel Hydrogel Sealant in a Canine Durotomy Repair Model

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