Department of Neurosurgery.
J Neurosurg Spine. 2013 Dec;19(6):736-43. doi: 10.3171/2013.8.SPINE12998. Epub 2013 Sep 27.
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.
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.
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).
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.
在脑和脊髓手术后，已有多种材料（如聚乙二醇（PEG）水凝胶和纤维蛋白胶）用于密封硬脑膜切口。虽然 PEG 密封剂的使用越来越普及，但它可能与术后脑脊液漏和感染有关。然而，目前尚不清楚其原因。本研究旨在探讨 PEG 密封剂和纤维蛋白胶对体内伤口愈合和脑损伤的影响。
在 22 只日本白兔的顶叶双侧创建椭圆形骨缺损和硬脑膜缺损。一侧硬脑膜缺损用 0.5ml 纤维蛋白胶覆盖，另一侧硬脑膜缺损用 0.5ml PEG 密封剂覆盖。使用光镜研究每个采集的大脑和硬脑膜中的硬脑膜再生和脑损伤。
与 PEG 密封剂相比，纤维蛋白胶存在时硬脑膜再生更有效（p=0.014）。在使用纤维蛋白胶的半球中，22 只兔子中有 11 只在术后 28 天表现出厚（+++和++）硬脑膜再生，而在 PEG 水凝胶半球中未观察到+++硬脑膜再生，只有 4 只兔子表现出++再生。当使用 PEG 水凝胶密封剂时，脓肿和肉芽形成也倾向于更严重。没有观察到纤维蛋白胶+++肉芽/脓肿形成，22 只兔子中只有 13 只观察到+级。相反，在使用 PEG 水凝胶密封剂的情况下，只有 2 只兔子没有形成肉芽/脓肿，8、7 和 5 只兔子分别观察到+、++和+++级的肉芽/脓肿。与没有这些病变的兔子相比，有脓肿和肉芽的兔子皮质损伤程度明显更大（p=0.007）。
纤维蛋白胶的硬脑膜再生更快，而 PEG 水凝胶密封剂更容易发生肉芽，这导致术后并发症。组织学分析表明，PEG 水凝胶密封剂抑制了正常组织愈合过程，使用纤维蛋白胶可改善结果。
Zotero 插件