Abstract
BackgroundPosterior fossa craniotomies can be complicated by cerebrospinal fluid (CSF) leaks, infection, meningitis, neurologic deficits, and intracranial hypotension caused by defective closure of the dura. Secondary dural closures such as pericranial graft, muscle graft, glue, sealants, or fat graft are used. However, there have been few studies examining the use of sealants with a polyethylene glycol and polyethylenimine component.ObjectiveWe studied the effect of one such sealant, Adherus® (HyperBranch Medical Technology, Durham, NC, USA), as an adjunct to secondary closure methods in the reduction of the use of abdominal fat grafting and lumbar puncture/drains.MethodsWe retrospectively reviewed the surgical records of all patients undergoing posterior fossa cranial surgery during a two-year period at a tertiary university affiliated medical center.ResultsOverall, data a total of 122 patients (62 in the no Adherus and 60 in the Adherus group) were collected. There was no statistically significant difference in the 30-day incisional CSF leak rate (4.1% vs. 6.5%; p=0.183), 30-day non-incisional CSF leak rate (11.3% vs. 5.0%; p=0.205), and 30-day pseudomeningocele rate (16.1% vs. 13.3%; p=0.663) in the no Adherus and Adherus groups, respectively. However, there was a significant reduction in the use of abdominal fat grafting (0% vs. 30.7%; p<0.001) and intraoperative CSF diversion techniques (58.1% vs. 23.3%; p<0.001). Every instance of the use of Adherus saved on average, $809.36.ConclusionsA statistically significant reduction in the use of CSF shunting procedures during posterior fossa craniotomy/craniectomy was achieved after the introduction of Adherus with no increase in CSF leak rate.
Highlights
A statistically significant reduction in the use of cerebrospinal fluid (CSF) shunting procedures during posterior fossa craniotomy/craniectomy was achieved after the introduction of Adherus with no increase in CSF leak rate
Posterior fossa craniotomies can be complicated by cerebrospinal fluid (CSF) leak, infection, meningitis, neurologic deficits, and intracranial hypotension, which may be caused by defective closure of the dura
With the introduction of Adherus, there was a conscious decision to decrease the use of abdominal fat grafting in retrosigmoid cases, and despite this, there was no significant increase in the rate of incisional CSF leak within 30 days (1.7% in the Adherus group and 6.5% in the no Adherus group) or formation of pseudomeningocele (13.3% in the Adherus group and 16.1% in the no Adherus group)
Summary
Posterior fossa craniotomies can be complicated by cerebrospinal fluid (CSF) leak, infection, meningitis, neurologic deficits, and intracranial hypotension, which may be caused by defective closure of the dura. There have been a few studies examining the use of sealants with a PEG and polyethylenimine (PEI) component One such dural sealant is Adherus® (HyperBranch Medical Technology, Durham, NC, USA), which is an FDA-approved product for use during brain surgery in patients aged 13 years or older intended to aid in preventing CSF leakage along the sutures by forming a watertight closure. Posterior fossa craniotomies can be complicated by cerebrospinal fluid (CSF) leaks, infection, meningitis, neurologic deficits, and intracranial hypotension caused by defective closure of the dura Secondary dural closures such as pericranial graft, muscle graft, glue, sealants, or fat graft are used. There have been few studies examining the use of sealants with a polyethylene glycol and polyethylenimine component
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