Terasaka S, Sawamura Y, Abe H
Department of Neurosurgery, University of Hokkaido School of Medicine.
No Shinkei Geka. 1994 Nov;22(11):1015-9.
Fibrin glue, a biologic adhesive, is made with highly concentrated human fibrinogen and clotting factors. It has become used frequently in neurosurgical procedures, in particular in the closure of the dura mata to prevent cerebrospinal fluid leakage. This report evaluates sealing effects of the fibrin glue on cerebrospinal fluid leakage through the dura. (1) Three manipulations for application of fibrin glue were used; i.e., layer, mixture and spray methods. These methods were compared to estimate their sealing effects on water leakage through a 1.2mm pore in an artificial dura. The burst pressure was significantly higher when the spray method was used than when the other two methods were used. (2) Dural incision was made and then sutured at intervals of 2mm, 3mm, 4mm, 6mm, and 8mm. Fibrin glue was applied by a spray method on the sutured dura. The burst pressure of the fibrin plate was over 80cmH2O on every interval of dural suture. (3) Dural defects 2mm, 4mm, 6mm, and 8mm in diameter were made, and then spray of fibrin glue was used to shield the defects. The fibrin clot spreading to the inner and outer surfaces of the pore defect was plug-shaped. The fibrin plug tolerated water pressure over 200cmH2O, in every size of pore. In conclusion, the optimal method for using fibrin glue on the surface of the dura was a spray method. Fibrin plate/clot made by the spray method sealed the dural tear or pore so well that it sustained a water pressure of over 80cmH2O, which is far higher than normal pressure of the intracranial cerebrospinal fluid.
纤维蛋白胶是一种生物粘合剂，由高浓度的人纤维蛋白原和凝血因子制成。它已在神经外科手术中频繁使用，特别是在硬脑膜闭合以防止脑脊液漏出方面。本报告评估了纤维蛋白胶对硬脑膜脑脊液漏出的封闭效果。（1）使用了三种应用纤维蛋白胶的方法，即分层法、混合法和喷雾法。对这些方法进行比较，以评估它们对人工硬脑膜上1.2毫米孔隙漏水的封闭效果。使用喷雾法时的破裂压力明显高于使用其他两种方法时的破裂压力。（2）制作硬脑膜切口，然后以2毫米、3毫米、4毫米、6毫米和8毫米的间隔进行缝合。通过喷雾法将纤维蛋白胶应用于缝合的硬脑膜上。在硬脑膜缝合的每个间隔处，纤维蛋白板的破裂压力均超过80厘米水柱。（3）制作直径为2毫米、4毫米、6毫米和8毫米的硬脑膜缺损，然后使用喷雾纤维蛋白胶来覆盖缺损。扩散到孔隙缺损内表面和外表面的纤维蛋白凝块呈栓塞状。在每种孔隙尺寸下，纤维蛋白栓塞都能承受超过200厘米水柱的水压。总之，在硬脑膜表面使用纤维蛋白胶的最佳方法是喷雾法。通过喷雾法制成的纤维蛋白板/凝块能很好地封闭硬脑膜撕裂或孔隙，使其能承受超过80厘米水柱的水压，这远高于颅内脑脊液的正常压力。
