Department of Neurosurgery, Brain Center Rudolph Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands.
Brain Technology Institute, Utrecht, The Netherlands.
Oper Neurosurg (Hagerstown). 2018 Oct 1;15(4):425-432. doi: 10.1093/ons/opx260.
Cerebrospinal fluid (CSF) leakage occurs in 4% to 32% of cranial surgeries and is associated with significant patient burden and expense. The use of sealant as an adjunct to primary dural closure is assumed to help prevent CSF leakage.
To examine the utility of different sealants for dural closure using an in Vitro model.
We evaluated 9 commonly used dural sealants, including Tachosil (Takeda Inc, Osaka, Japan), Adherus (Hyperbranch Inc, Durham, North Carolina), Duraform (Codman, Raynham, Massachusetts), Tissudura (Baxter, Deerfield, Illinois), Hemopatch (Baxter), TissuePatchDural (Tissuemed, Leeds, United Kingdom), Tisseel (Baxter), Duragen Secure (Integra, Plainsboro, New Jersey), and Duraseal, (Integra). Sealants were tested in 2 novel in Vitro setups using fresh porcine dura: the first tested the acute burst pressure of a sealed 3-mm gap, while the second examined resistance to a pressure wave mimicking intracranial pressure for 72 h.
Adherus showed the highest mean burst pressure (87 ± 47 mmHg) followed by Tachosil (71 ± 16 mmHg) and Duraseal (51 ± 42 mmHg); these were the only 3 sealants showing burst pressures above normal physiological intracranial pressure. In the 72-h setup, only Adherus and Duraseal maintained appropriate sealing for the duration of the experiment. Tachosil released from the dura after 1.4 h (95% confidence interval, -1.8-4.7).
Given the high cost of sealants and the results of this study, we advocate a critical attitude toward sealant application as an adjunct to classic dural closure.
脑脊液（CSF）漏发生在 4%至 32%的颅手术中，与患者负担和费用显著增加有关。使用密封剂作为硬脑膜缝合的辅助手段，被认为有助于预防 CSF 漏。
通过体外模型研究不同硬脑膜密封剂的应用效果。
我们评估了 9 种常用的硬脑膜密封剂，包括 Tachosil（武田制药，大阪，日本）、Adherus（Hyperbranch 公司，北卡罗来纳州达勒姆）、Duraform（Codman，雷纳姆，马萨诸塞州）、Tissudura（百特，迪尔菲尔德，伊利诺伊州）、Hemopatch（百特）、TissuePatchDural（Tissuemed，利兹，英国）、Tisseel（百特）、Duragen Secure（英特格拉，普林斯伯勒，新泽西州）和 Duraseal。密封剂在 2 种使用新鲜猪硬脑膜的新型体外设置中进行了测试：第一种测试了密封 3mm 间隙的急性爆裂压力，第二种测试了模拟颅内压 72 小时的压力波的阻力。
Adherus 的平均爆裂压力最高（87 ± 47mmHg），其次是 Tachosil（71 ± 16mmHg）和 Duraseal（51 ± 42mmHg）；这是仅有的 3 种密封剂爆裂压力高于正常生理颅内压的密封剂。在 72 小时的设置中，只有 Adherus 和 Duraseal 在整个实验过程中保持了适当的密封。Tachosil 在 1.4 小时后从硬脑膜上释放（95%置信区间，-1.8-4.7）。
鉴于密封剂的高成本和本研究的结果，我们主张对密封剂的应用持批评态度，将其作为经典硬脑膜缝合的辅助手段。
