42 - Evolution of synthetic graft materials and dural sealants for cerebrospinal fluid leak repair

Abstract

Numerous methods have been developed over the years to assist in providing optimal outcomes and minimize postoperative cerebrospinal fluid leak (CSF) rates after skull base surgery. Especially inherent to the endoscopic approach is incision or resection of dura, which can vary from being only limited to the sella to involving more extensive dural surfaces (e.g., cribriform plate, planum sphenoidale, clivus). Although dependent on surgeon preference and skill as well as the type of defect and extent of flow, repairs are commonly achieved with a combination of underlay (subdural, epidural, or both) and an overlay graft or flap, with intervening absorbable hemostatic agents (e.g., cellulose, gelatin foam) and, in certain cases, an absorbable glue or sealant as adjuncts. The goal is to simulate a reliable dural substitute that can achieve a watertight closure to prevent egress of CSF, minimize intracranial infection, and provide a surface along which the wound can form neodura. Ultimately, most modern repairs consist of some combination of free autografts, vascularized flaps, synthetic dural replacement grafts, and synthetic absorbable sealants and glues.