Schiariti Marco, Acerbi Francesco, Broggi Morgan, Tringali Giovanni, Raggi Alberto, Broggi Giovanni, Ferroli Paolo
Department of Neurosurgery, Public Health and Disability Unit, Fondazione Istituto Neurologico Besta, Milan, Italy.
Department of Neurology, Public Health and Disability Unit, Fondazione Istituto Neurologico Besta, Milan, Italy.
Surg Neurol Int. 2014 Dec 3;5:171. doi: 10.4103/2152-7806.146154. eCollection 2014.
Post-operative cerebrospinal fluid (CSF) leak in posterior fossa surgery remains a significant source of morbidity. TissuePatchDural (TPD), a novel impermeable adhesive membrane, was used to reinforce dural closure. A comparison with one of the most commonly used dural sealing devices, DuraSeal, has been made.
A retrospective, single-center study was conducted on 161 patients who underwent elective posterior fossa surgery. On surgeon's opinion, when a primary watertight closure was not possible, they received TPD or DuraSeal to reinforce dural closure.
Out of 161 patients analyzed, 115 were treated with TPD and 46 with DuraSeal. The post-operative leaks related purely to TPD or DuraSeal failure were recognized in 3 (2.6%) and 5 (10.86%) cases, respectively (P = 0.015). The presence of pre- and post-operative risk factors was associated with an increased incidence of CSF leak in both groups. TPD showed a better control in patients without these risk factors (P = 0.08). The incidence of CSF leak in patients who underwent posterior fossa surgery by craniectomy was statistically lower in TPD group compared to DuraSeal group (3.22% vs 17.8%, respectively; P = 0.008).
TPD seems to be a safe tool for use as an adjunct to standard dural closure in posterior fossa surgery, particularly in patients without pre- or post-oper ative risk factors, in those who did not develop hydrocephalus, and who underwent craniectomy. The CSF leak rate in TPD group was found to be lower or within the range of the more advanced alternative dural closure strategies, including polyethylene glycol (PEG)-based sealant.
后颅窝手术后脑脊液漏仍是一个重要的发病原因。新型不可渗透的黏附性膜TissuePatchDural（TPD）被用于加强硬脑膜封闭。已将其与最常用的硬脑膜封闭装置之一DuraSeal进行了比较。
对161例行择期后颅窝手术的患者进行了一项回顾性单中心研究。根据外科医生的意见，当无法进行初次水密性封闭时，他们接受TPD或DuraSeal以加强硬脑膜封闭。
在分析的161例患者中，115例接受了TPD治疗，46例接受了DuraSeal治疗。分别在3例（2.6%）和5例（10.86%）中发现术后漏液纯粹与TPD或DuraSeal失效有关（P = 0.015）。术前和术后危险因素的存在与两组脑脊液漏发生率的增加相关。TPD在无这些危险因素的患者中显示出更好的控制效果（P = 0.08）。与DuraSeal组相比，TPD组中通过颅骨切除术进行后颅窝手术的患者脑脊液漏发生率在统计学上更低（分别为3.22%和17.8%；P = 0.008）。
TPD似乎是后颅窝手术中作为标准硬脑膜封闭辅助手段的一种安全工具，特别是对于没有术前或术后危险因素、未发生脑积水且接受颅骨切除术的患者。发现TPD组的脑脊液漏率较低或处于更先进的替代硬脑膜封闭策略（包括基于聚乙二醇（PEG）的密封剂）的范围内。
