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

Preul, Mark C.; Bichard, William D.; Muench, Timothy R.; Spetzler, Robert F.

doi:10.1227/01.neu.0000089481.87226.f7

Cited by 98 publications

(84 citation statements)

References 53 publications

(60 reference statements)

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“…In addition, the material should also be thin in order not to create tension between dural edges. There were interesting reports pointing to prevention of adhesions in cranial or spinal epidural layer (3,4,6,13,20). In the present study, no fibrosis was observed in most of the samples of the Spongostan™ group and looser connective tissue dominates the field of study with irregularly arranged thin collagen fibers and fibroblasts.…”

Section: Discussionsupporting

confidence: 51%

Use of spongostan on prevention of cranial subdural adhesions following craniotomy in a rabbit model

Özdöl

Alagöz²,

Yıldırım³

et al. 2014

Turkish Neurosurgery

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AIm: Spongostan™ is a sterile, water-insoluble, porcine gelatin absorbable sponge, which is widely used as a hemostatic material. The aim of this study is to test the anti-fibrotic capacity of Spongostan™, using a craniotomy model in an experimental rabbit model. mAterIAl and methOds: Eighteen rabbits were divided into two groups: Each group consisted of 9 rabbits, duratomy plus Spongostan™ (group 1), and duratomy without Spongostan™ (group 2). Right parietal bone was removed via trephine and low speed drill and dura was opened. On the group 1 rabbits, an appropriate piece of Spongostan™ was meticulously placed under dural layer. On group 2 rabbits, same procedures were repeated without Spongostan™. Histological sections were taken from each group and evaluated for degree of fibrosis and collagen fibers. results:There was marked increase in number of fibroblasts and collagen fibers in group 2 rabbits, however most of the rabbits in Spongostan™ group demonstrate scarce histopathological findings for fibrosis. COnClusIOn:We conclude that an appropriately placed subdural Spongostan™ over cerebral tissue may prevent postoperative surgical adhesions after neurosurgical operations.

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Section: Discussionsupporting

confidence: 51%

Use of spongostan on prevention of cranial subdural adhesions following craniotomy in a rabbit model

Özdöl

Alagöz²,

Yıldırım³

et al. 2014

Turkish Neurosurgery

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“…However, one of the drawbacks of using DuraSeal TM is its potential to swell up to 50% and its slow resorption rate. The peak expansion of DuraSeal TM was between 3 and 14 days postapplication in a dog model with complete resorption at 8 weeks [6,10]. Owing to these findings, we believe the application of DuraSeal TM in a confined bony area is contraindicated as a result of the concern of swelling and nerve root compression (DuraSeal TM product information.…”

Section: Discussionmentioning

confidence: 95%

Cauda Equina Syndrome After a TLIF Resulting From Postoperative Expansion of a Hydrogel Dural Sealant

Neuman

Radcliff

Rihn

2012

Clinical Orthopaedics &Amp; Related Research

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Background DuraSeal TM (Coviden, Waltham, MA, USA), a hydrogel sealant, is primarily used as an adjunct to a dural repair. Its use has also been described to seal off an annulotomy after a transforaminal lumbar interbody fusion when recombinant human bone morphogenetic protein-2 (rhBMP-2) is used. This aids in the reduction of postoperative radiculitis caused by rhBMP-2. However, as a result of its hydrophilic properties, DuraSeal TM has the potential to swell, which could lead to compression of the thecal sac. Case Description We report a 57-year-old woman who developed cauda equina after a transforaminal lumbar 47 interbody fusion (TLIF) procedure in which the expansion of the DuraSeal TM was believed to be the causative factor. The patient developed urinary retention, bowel incontinence, and paresthesias in the saddle region on postoperative Day 3. She underwent emergent exploration and decompression of the thecal sac. The gel-like DuraSeal TM material was causing significant compression of the thecal sac. Literature Review Multiple reports have documented that DuraSeal TM , used as an adjunct to dural repair, can swell leading to compression of the spinal cord and/or neural elements. Our case demonstrates the use of DuraSeal TM both over a site of a dural repair and over an annulotomy site, through which a TLIF was performed, is associated with the risk of developing postoperative cauda equina syndrome as a result of swelling of the DuraSeal TM . Clinical Relevance Those using DuraSeal TM to seal off the annulotomy after a TLIF procedure performed with rhBMP-2 should use the product with an understanding of the potential postoperative swelling of the product and resulting neurologic sequela, particularly if DuraSeal TM is used concomitantly at the site of dural repair.

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“…2,3,[14][15][16] This hydrogel sealant system can also be used to seal dural defects. Polyethylene glycol hydrogel sealant is a chemical synthetic sealant formed by mixing PEG ester solution and trilysine amine solution.…”

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confidence: 99%

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

Cited by 98 publications

References 53 publications

Use of spongostan on prevention of cranial subdural adhesions following craniotomy in a rabbit model

Use of spongostan on prevention of cranial subdural adhesions following craniotomy in a rabbit model

Cauda Equina Syndrome After a TLIF Resulting From Postoperative Expansion of a Hydrogel Dural Sealant

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

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