Clinical Experience with Hemopatch® as a Dural Sealant in Cranial Neurosurgery.

Karl-Michael Schebesch,Alexander Brawanski

doi:10.7759/cureus.4013

Abstract

Background: Herein, we report our clinical experience with the novel polyethylene glycol-covered matrix dural onlay, Hemopatch® (Baxter Deutschland GmbH, Unterschleißheim, Germany) for the prevention of postoperative cerebrospinal fluid (CSF) fistulas.Methods: Retrospectively, 22 consecutive patients (11 females, 11 males, mean age: 49.8 years, range: 15–77 years) with oncological and vascular intracranial lesions were included in this study. In all patients, the Hemopatch was applied as the dural onlay. The accuracy of the primary dural sutures was distinguished into 1) no visible gaps, 2) small gaps < 3 mm, and 3) large gaps > 3 mm. We evaluated the patient charts, surgical reports, and postoperative images. The median follow-up was three months. We recorded any wound healing disorder, such as infection or CSF fistula, and postoperative hemorrhage resulting in surgical revision.Results: Supratentorial, infratentorial, and transsphenoidal approaches were conducted in 17, four, and one patient, respectively. Accurate sutures without visible gaps, small gaps, and large gaps were covered with the Hemopatch in 11, eight, and three patients. One patient developed a CSF fistula (4.5%), one patient had a wound infection (4.5%), and in one patient, a remote cerebellar hemorrhage occurred (unrelated to the dural closure) (4.5%). Thus, the surgical revision rate due to wound healing disorders was 9% (2/22).Conclusion: It is safe and feasible to use the Hemopatch as a dural sealant. The rate of postoperative wound healing disorders in our population was in the lower range of reported surgical revision rates after supra-/infratentorial craniotomies. However, prospective and controlled clinical trials are still warranted.

Highlights

The reported rate of cerebrospinal fluid (CSF) leakage after craniotomy ranges widely from 4% - 32% [1,2] and, up to 17% after infratentorial approaches [3,4]
A watertight dural closure can be achieved by direct suturing of the dural rims; eventually, an autologous graft-like muscle flap or periosteum is placed on visible gaps and fixed to the dura by additional sutures or with fibrin glue
We focused on the rate of wound healing disorders, such as CSF leakages and wound infections, within 12 weeks after surgery

Summary

Introduction

The reported rate of cerebrospinal fluid (CSF) leakage after craniotomy ranges widely from 4% - 32% [1,2] and, up to 17% after infratentorial approaches [3,4]. CSF fistulas are not the only significant contributors to a surgical site infection [5]. CSF leakages are among the most frequently reported indicators for surgical revisions, frequently delaying the start of adjuvant treatment and early rehabilitation in neurooncological diseases or after brain trauma. The annual socioeconomic burden is high due to extensive re-treatment of the CSF-fistula [6]. We report our clinical experience with the novel polyethylene glycol-covered matrix dural onlay, Hemopatch® (Baxter Deutschland GmbH, Unterschleißheim, Germany) for the prevention of postoperative cerebrospinal fluid (CSF) fistulas

Methods

Results

Conclusion