Epstein Nancy E
Chief of Neurosurgical Spine, Education, and Research Winthrop University Hospital, Mineola, N.Y., USA, 11501.
Surg Neurol Int. 2014 Aug 28;5(Suppl 7):S304-14. doi: 10.4103/2152-7806.139615. eCollection 2014.
Fibrin sealants (FS)/glues (FG) are primarily utilized in spinal surgery to either strengthen repairs of elective (e.g., intradural tumors/pathology) or traumatic cerebrospinal fluid (CSF) fistulas. Here, additional roles/benefits of FS/FG in spine surgery are explored; these include increased hemostasis, reduction of scar, reduction of the risk of infection if impregnated with antibiotics, and its application to restrict diffusion and limit some of the major complications attributed to the controversial "off-label" use of bone morphogeneitc protein (rhBMP-2/INFUSE).
We reviewed multiple studies, focusing not just on the utility of FS/FG in the treatment of CSF fistulas, but on its other applications.
FS/FG have been primarily used to supplement elective/traumatic dural closure in spinal surgery. However, FS/FG also contribute to; hemostasis, reducing intraoperative/postoperative bleeding/transfusion requirements, length of stay (LOS)/costs, reduced postoperative scar/radiculitis, and infection when impregnated with antibiotics. Nevertheless, one should seriously question whether FS/FG should be applied to prevent diffusion and limit major complications attributed to the "off-label" use of BMP/INFUSE (e.g., limit/prevent heterotopic ossification, dysphagia/respiratory decompensation, and new neurological deficits).
FS/FG successfully supplement watertight dural closure following elective (e.g., intradural tumor) or traumatic CSF fistulas occurring during spinal surgery. Additional benefits include: intraoperative hemostasis with reduced postoperative drainage, reduced transfusion requirements, reduced LOS, cost, scar, and prophylaxis against infection (e.g., impregnated with antibiotics). However, one should seriously question whether FS/FG should be used to contain the diffusion of BMP/INFUSE and limit its complications when utilized "off-label".
纤维蛋白密封剂（FS）/胶水（FG）主要用于脊柱手术，以加强择期手术（如硬膜内肿瘤/病变）或创伤性脑脊液（CSF）瘘的修复。在此，探讨FS/FG在脊柱手术中的其他作用/益处；这些包括增强止血、减少瘢痕形成、若用抗生素浸渍则降低感染风险，以及其用于限制扩散并限制一些因有争议的骨形态发生蛋白（rhBMP-2/INFUSE）“非标签”使用所致的主要并发症。
我们回顾了多项研究，不仅关注FS/FG在治疗CSF瘘中的效用，还关注其其他应用。
FS/FG主要用于脊柱手术中辅助择期/创伤性硬脑膜闭合。然而，FS/FG还有助于：止血，减少术中/术后出血/输血需求、住院时间（LOS）/费用，减少术后瘢痕/神经根炎，以及用抗生素浸渍时预防感染。尽管如此，人们应认真质疑FS/FG是否应用于预防扩散并限制因BMP/INFUSE“非标签”使用所致的主要并发症（如限制/预防异位骨化、吞咽困难/呼吸代偿失调和新的神经功能缺损）。
FS/FG成功辅助脊柱手术中择期手术（如硬膜内肿瘤）或创伤性CSF瘘后的水密性硬脑膜闭合。其他益处包括：术中止血并减少术后引流，减少输血需求，缩短住院时间、降低费用、减少瘢痕形成，以及预防感染（如用抗生素浸渍）。然而，人们应认真质疑FS/FG在“非标签”使用时是否应用于抑制BMP/INFUSE的扩散并限制其并发症。
