Two alternative dural sealing techniques in posterior fossa surgery: (Polylactide-co-glycolide) self-adhesive resorbable membrane versus polyethylene glycol hydrogel.

Abstract

Background:Post-operative cerebrospinal fluid (CSF) leak in posterior fossa surgery remains a significant source of morbidity. TissuePatchDural (TPD), a novel impermeable adhesive membrane, was used to reinforce dural closure. A comparison with one of the most commonly used dural sealing devices, DuraSeal, has been made.Methods:A retrospective, single-center study was conducted on 161 patients who underwent elective posterior fossa surgery. On surgeon's opinion, when a primary watertight closure was not possible, they received TPD or DuraSeal to reinforce dural closure.Results:Out of 161 patients analyzed, 115 were treated with TPD and 46 with DuraSeal. The post-operative leaks related purely to TPD or DuraSeal failure were recognized in 3 (2.6%) and 5 (10.86%) cases, respectively (P = 0.015). The presence of pre- and post-operative risk factors was associated with an increased incidence of CSF leak in both groups. TPD showed a better control in patients without these risk factors (P = 0.08). The incidence of CSF leak in patients who underwent posterior fossa surgery by craniectomy was statistically lower in TPD group compared to DuraSeal group (3.22% vs 17.8%, respectively; P = 0.008)Conclusions:TPD seems to be a safe tool for use as an adjunct to standard dural closure in posterior fossa surgery, particularly in patients without pre- or post-oper ative risk factors, in those who did not develop hydrocephalus, and who underwent craniectomy. The CSF leak rate in TPD group was found to be lower or within the range of the more advanced alternative dural closure strategies, including polyethylene glycol (PEG)-based sealant.