The Use of Fibrin Sealant in Chiari Malformation Type-1 Surgery; Is It Effective in Preventing the Formation of CSF Fistula?

Abstract

Background: Symptomatic disease requires surgical intervention comprising of posterior fossa decompression with or without an expansile duraplasty. Until date, the optimal surgical treatment for CM-1 has not been delineated. Thus, we evaluated the results to assess the effectiveness of fibrin sealant augmentation in combination with locally harvested autologous pericranium for duraplasty in adult CM-1 decompression. Materials and Methods: We retrospectively evaluated the cases that were operated due to CM-1. The cases were divided into two groups in which fibrin sealant (FS) was used and not used. There were 15 patients in the first group (FS group) and 16 in the second group (no fibrin sealant (NFS) group). We followed the standardized surgical technique suggested by Stevens and colleagues for CM 1 decompression. Results: Cerebrospinal fluid (CSF) fistula was not observed in any patient in the FS group. However, in the NFS group, two patients were reported to develop CSF fistula. Although the findings are not statistically significant, these are clinically important. Conclusion: Use of FS to seal the autologous graft during closure may prevent the occurrence of CSF fistula among patients of CM-1.