The Use Fibrin Sealant after Spinal Intradural Tumor Surgery: Is It Necessary?

Won, Young Il; Kim, Chi Heon; Chung, Chun Kee; Jahng, Tae-Ahn; Park, Sung Bae

doi:10.14245/kjs.2016.13.1.24

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…Use of fibrin sealants has been discouraged by several authors following both planned and unplanned durotomies due to a lack of effectiveness in preventing CSFL ( 10 , 14 – 16 ), even though two studies reported favorable results ( 4 , 17 ). The effectiveness and the necessity of patch sealants to prevent CSFL are not sufficiently studied in planned durotomies.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical management

et al. 2022

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BackgroundCerebrospinal fluid leakage (CSFL) following spinal durotomy can lead to severe sequelae. However, while several studies have investigated accidental spinal durotomies, the risk factors and influence of clinical management in planned durotomies remain unclear.MethodsWe performed a retrospective analysis of all patients who underwent planned intradural spinal surgery at our institution between 2010 and 2020. Depending on the occurrence of a CSFL, patients were dichotomized and compared with respect to patient and case-related variables as well as dural closure technique, epidural drainage placement, and timing of mobilization.ResultsA total of 351 patients were included. CSFL occurred in 4.8% of all cases. Surgical indication, tumor histology, location within the spine, previous intradural surgery, and medical comorbidities were not associated with an increased risk of CSFL development (all p > 0.1). Age [odds ratio (OR), 0.335; 95% confidence interval (CI), 0.105–1.066] and gender (OR, 0.350; 95% CI, 0.110–1.115) were not independently associated with CSFL development. There was no significant association between CSFL development and the dural closure technique (p = 0.251), timing of mobilization (p = 0.332), or placement of an epidural drainage (p = 0.321).ConclusionCSFL following planned durotomy pose a relevant and quantifiable complication risk of surgery that should be factored in during preoperative patient counseling. Our data could not demonstrate superiority of any particular dural closure technique but support the safety of both early mobilization within 24 h postoperatively and epidural drainage with reduced or no force of suction.

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Section: Discussionmentioning

confidence: 99%

Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical management

et al. 2022

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“…Frequently, durotomy margin is uneven, and watertight dural closure cannot be achieved only by single sutures. In such cases, the use of a sealant is helpful [ 45 – 49 ].…”

Section: Spinal Cordmentioning

confidence: 99%

Multiple uses of fibrin sealant for nervous system treatment following injury and disease

Biscola

Cartarozzi

Ulian-Benitez

et al. 2017

J Venom Anim Toxins Incl Trop Dis

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Lesions to the nervous system often produce hemorrhage and tissue loss that are difficult, if not impossible, to repair. Therefore, scar formation, inflammation and cavitation take place, expanding the lesion epicenter. This significantly worsens the patient conditions and impairment, increasing neuronal loss and glial reaction, which in turn further decreases the chances of a positive outcome. The possibility of using hemostatic substances that also function as a scaffold, such as the fibrin sealant, reduces surgical time and improve postoperative recovery. To date, several studies have demonstrated that human blood derived fibrin sealant produces positive effects in different interventions, becoming an efficient alternative to suturing. To provide an alternative to homologous fibrin sealants, the Center for the Study of Venoms and Venomous Animals (CEVAP, Brazil) has proposed a new bioproduct composed of certified animal components, including a thrombin-like enzyme obtained from snake venom and bubaline fibrinogen. Thus, the present review brings up to date literature assessment on the use of fibrin sealant for nervous system repair and positions the new heterologous bioproduct from CEVAP as an alternative to the commercial counterparts. In this way, clinical and pre-clinical data are discussed in different topics, ranging from central nervous system to peripheral nervous system applications, specifying positive results as well as future enhancements that are necessary for improving the use of fibrin sealant therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s40409-017-0103-1) contains supplementary material, which is available to authorized users.

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“…The clinical evidence for sealants is still debated, with a recent review [ 9 ] recognizing the paucity of randomized control trials (RCTs) examining sealants in dural closure. Specific to intradural pathologies, retrospective studies have not demonstrated the superiority of fibrin sealants [ 10 , 11 ]. Although RCTs have demonstrated the efficacy of autologous fibrin tissue [ 12 ] and hydrogel sealants [ 13 ], a systematic review by Choi et al [ 14 ] suggested that sealants as an adjunct to primary closure did not reduce the rate of CSF leak.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Cerebrospinal Fluid Leak Following Dural Repair in Spinal Intradural Surgery

Jiang,

Budu,

Khan

et al. 2023

Neurospine

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Objective: We aim to compare the effectiveness of dural closure techniques in preventing cerebrospinal fluid (CSF) leaks following surgery for intradural lesions and seek to identify additional factors associated with CSF leaks. Surgical management of spinal intradural lesions involves durotomy which requires a robust repair to prevent postoperative CSF leakage. The ideal method of dural closure and the efficacy of sealants has not been established in literature.Methods: We performed a retrospective analysis of all intradural spinal cases performed at a tertiary spine centre from 1 April 2015 to 29 January 2020 and collected data on patient bio-profile, dural repair technique, and CSF leak rates. Multivariate analysis was performed to identify predictors for postoperative CSF leak.Results: A total of 169 cases were reported during the study period. There were 15 cases in which postoperative CSF leak was reported (8.87%). Multivariate analysis demonstrated that patient age (odds ratio [OR], 0.942; 95% confidence interval [CI], 0.891–0.996), surgical indication listed in the “others” category (OR, 44.608; 95% CI, 1.706–166.290) and dural closure with suture, sealant and patch (OR, 22.235; 95% CI, 2.578–191.798) were factors associated with CSF leak. Postoperative CSF leak was associated with the risk of surgical site infection with a likelihood ratio of 8.704 (χ² (1) = 14.633, p < 0.001).Conclusion: Identifying predictors for CSF leaks can assist in the counselling of patients with regard to surgical risk and expected postoperative recovery.

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The Use Fibrin Sealant after Spinal Intradural Tumor Surgery: Is It Necessary?

Cited by 5 publications

References 29 publications

Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical management

Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical management

Multiple uses of fibrin sealant for nervous system treatment following injury and disease

Predictors of Cerebrospinal Fluid Leak Following Dural Repair in Spinal Intradural Surgery

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