Kizmazoglu Ceren, Ozyoruk Safak, Husemoglu Resit Bugra, Kalemci Orhan, Sozer Gulden, Sade Burak
Department of Neurosurgery, Dokuz Eylul University School of Medicine, Izmir, Turkey.
Department of Neurosurgery, Ardahan State Hospital, Ardahan, Turkey.
Br J Neurosurg. 2019 Dec;33(6):655-658. doi: 10.1080/02688697.2019.1667481. Epub 2019 Sep 22.
Dural closure preference has been a topic of debate in contemporary neurosurgery. This study aims to compare different closure techniques using an in vitro model. Human cadaveric dura mater was attached to a cylindrical metal glass filled with blue dyed saline. A 1 cm dural incision was made. Dural closure was performed using three different techniques. Each group had six samples: Group I - interrupted simple 4-0 polyglactin suture (S) only, Group II - S plus on lay collagen graft, Group III - S plus fibrin sealant. In Group NS, a 1 cm × 1 cm dural window was made. An onlay collagen graft was used with no suturing for this group to serve as an overtly weak reconstruction reference. Primary and secondary leak pressures were recorded (PLP and SLP, respectively). All groups (I-III) had significantly higher PLP and SLP than Group NS. PLP was significantly higher in Group III as compared to groups I and II. Groups I and II had similar PLP values. SLP was similar in all three groups. In this study, the use of fibrin sealant has proven to be the best option in preventing dural leak. However, no technique was superior in the case of SLP.
在当代神经外科手术中，硬膜关闭方式一直是一个争论的话题。本研究旨在使用体外模型比较不同的关闭技术。将人类尸体硬脑膜附着在一个装有蓝色染色盐水的圆柱形金属玻璃上。做一个1厘米的硬膜切口。使用三种不同技术进行硬膜关闭。每组有六个样本：第一组——仅用间断单纯4-0聚乙醇酸缝线（S），第二组——S加覆盖胶原移植物，第三组——S加纤维蛋白密封剂。在无缝合组，制作一个1厘米×1厘米的硬膜窗口。该组使用覆盖胶原移植物且不进行缝合，作为明显薄弱重建的对照。记录初次和二次漏液压力（分别为PLP和SLP）。所有组（I - III）的PLP和SLP均显著高于无缝合组。与第一组和第二组相比，第三组的PLP显著更高。第一组和第二组的PLP值相似。三组的SLP相似。在本研究中，已证明使用纤维蛋白密封剂是预防硬膜漏液的最佳选择。然而，在SLP方面没有一种技术更具优势。
