Shah Anil R, Pearlman Aaron N, O'Grady Kevin M, Bhattacharyya Tappan K, Toriumi Dean M
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York 10016, USA.
Am J Rhinol. 2007 Sep-Oct;21(5):619-21. doi: 10.2500/ajr.2007.21.3078.
The management of cerebrospinal fluid (CSF) leaks can be challenging. Acellular dermal grafts derived from human cadavers can be used as a replacement material when autogenous materials are unavailable. Fibrin tissue adhesive (FTA) is a wound support product that has been used for hemostatic and tissue fixation purposes. The combined use of acellular dermis in conjunction with FTA for dural repair remains a subject of study. The aim of this study was to evaluate wound healing and tissue compatibility characteristics of acellular dermal substitute material when used both with and without FTA, for repair of a dural tear in a chinchilla model.
Forty-nine chinchillas were included in this randomized case-control study. The squamous portion of the temporal bone was removed to expose the tegmen. A 2 x 2 mm dural defect was removed to create an iatrogenic CSF leak. Then, animals were randomly assigned to one of three treatment groups: group 1, acellular dermis alone; group 2, acellular dermis with FTA; group 3, fibrinogen, acellular dermis, and FTA. Surgical sites were examined grossly at 1- and 2-week intervals. Temporal bones were examined histologically.
Grossly, groups 2 and 3 had significantly less visible CSF leak and brain herniation noted at both 1- and 2-week intervals when compared with group 1. Histological results confirmed the gross results showing the best seal in group 2 and 3.
Acellular dermis combined with FTA provided superior support compared with acellular dermis alone in repair of induced dural defects.
脑脊液（CSF）漏的处理可能具有挑战性。当无法获得自体材料时，源自人类尸体的脱细胞真皮移植物可用作替代材料。纤维蛋白组织粘合剂（FTA）是一种伤口支持产品，已用于止血和组织固定目的。脱细胞真皮与FTA联合用于硬脑膜修复仍是一个研究课题。本研究的目的是评估在豚鼠模型中，脱细胞真皮替代材料在联合或不联合FTA用于修复硬脑膜撕裂时的伤口愈合和组织相容性特征。
本随机病例对照研究纳入了49只豚鼠。切除颞骨的鳞状部分以暴露颅中窝。去除一个2×2mm的硬脑膜缺损以造成医源性脑脊液漏。然后，将动物随机分配到三个治疗组之一：第1组，单独使用脱细胞真皮；第2组，脱细胞真皮联合FTA；第3组，纤维蛋白原-脱细胞真皮-FTA。在1周和2周间隔时对手术部位进行大体检查。对颞骨进行组织学检查。
大体观察，与第1组相比，第2组和第3组在1周和2周间隔时可见的脑脊液漏和脑疝明显更少。组织学结果证实了大体观察结果，显示第2组和第3组封闭效果最佳。
在修复诱导性硬脑膜缺损时，与单独使用脱细胞真皮相比，脱细胞真皮联合FTA提供了更好的支持。
