Fibrin Glue Research Articles

Comparison of transposition and interposition methods in microvascular decompression for hemifacial spasm: an analysis of 109 cases performed by a single surgeon in a single-center retrospective study

BackgroundMicrovascular decompression (MVD), the standard surgical approach for hemifacial spasm (HFS), can be divided into the interposition and transposition methods. Although the risk of HFS recurrence following interposition has been reported, there is limited data comparing long-term outcomes between both methods performed by a single surgeon. This study aimed to investigate the efficacy of MVD techniques on HFS by comparing surgical outcomes performed by a single surgeon in a single-center setting.MethodsA total of 109 patients who underwent MVD were analyzed and divided into the transposition (86 patients) and interposition (23 patients) groups. Postoperative outcomes at 1 month and 1 year were assessed and compared, including rates of spasm relief, complications, and recurrence.ResultsOutcome assessment revealed higher rates of early spasm relief in the interposition group (66.3% vs. 100%, transposition vs. interposition, respectively, p = 0.0004), although spasm relief at 1-year postoperatively was comparable between the two groups (84.9% vs. 95.7%, transposition vs. interposition, respectively, p = 0.2929). No significant differences were observed in complication and recurrence rates. Kaplan–Meier analysis demonstrated no significant differences in the duration of spasm resolution by MVD method (p = 0.4347, log-rank test).ConclusionThis study shows that both the transposition (Surgicel® and fibrin glue) and interposition (sponge) methods were excellent surgical techniques. The interposition method may achieve earlier spasm resolution compared to the transposition method.

Safety and effectiveness of evicel®fibrin sealant as an adjunct to sutured dural repair in children undergoing cranial neurosurgery.

Cerebrospinal fluid (CSF) leakage is a challenging complication of intradural cranial surgery, and children are particularly at risk. The use of dural sealants confers protection in adults, but pediatric studies are scarce. We evaluated the safety and efficacy of Evicel® fibrin sealant as an adjunct to primary dural suturing in children undergoing cranial surgery. A multicenter trial prospectively enrolled pediatric subjects (< 18years) undergoing cranial neurosurgery who, upon completion of primary sutured dural repair, experienced CSF leakage. As agreed by the EMA Evicel® Pediatric Investigation Plan, 40 subjects were intra-operatively randomized 2:1 to Evicel® or additional sutures ('Sutures'). Data analysis was descriptive. The efficacy endpoint was treatment success rate, with success defined as intra-operative watertight closure after provocative Valsalva maneuver (primary endpoint). Safety endpoints were postoperative CSF leakage (incisional CSF leakage, pseudomeningocele or both) and surgical site complications (secondary endpoints). Forty subjects (0.6-17years) were randomized to Evicel® (N = 25) or Sutures (N = 15) (intention-to-treat). Intracranial tumor was the most common indication and procedures were mostly supratentorial craniotomies. Success rates were 92.0% for Evicel® and 33.3% for Sutures, with a 2.76 estimated ratio of success rates (Farrington-Manning 95% CI [1.53, 6.16]). Sensitivity analyses in per-protocol and safety sets showed similar results. Despite a higher rescue treatment rate, the frequencies of postoperative CSF leakage and wound complications were higher for Sutures than for Evicel®. This small-scale prospective study shows Evicel® treatment to be safe and effective as an adjunct to primary sutured dura mater closure in a pediatric population. Compared to additional sutures, Evicel® was associated with reduced postoperative CSF leakage and surgical site complications. (Trial registration: The trial was registered as NCT02309645 and EudraCT 2013-003558-26).

Comparison of digital nerve repair techniques: a systematic review

Introduction: Digital nerves are the most injured upper limb peripheral nerves [1]. There are numerous different methods of repair, with no standardised treatment options or guidelines. This systematic review aims to evaluate literature that investigated thebiomechanical strength of digital nerve repairs through varying methods in cadaveric models.Aims/Hypothesis: The aim of the study is to evaluate the literature available for digital nerve repairs and directly compare which surgical method yields the best results. The primary outcome is maximum load to failure of the repaired digital nerve following biomechanical (tensile) strength testing. We postulate that out of all the repair methods, augmentation of repair with fibrin glue or additional conduit will increase the load to failure compared to suture only repair.Methodology: We utilised the PRISMA methodology to conduct the systematic review. The following databases were searched: Embase, Medline, Cochrane, and Web of Science. Studies were reviewed and screened by two researchers following an inclusion and exclusion strategy to retrieve relevant papers.Results: A total of seven papers were included in the final review; these papers reported biomechanical data on cadaveric digital nerve repairs. Due to heterogenicity of methods between papers, a combination of quantitative and qualitative analysis of the results was made.Conclusion: The use of minimal suturing with conduit or glue or both has the ability to increase the maximum load to failure of digital nerve repairs compared to suture only methods. This has additional benefits to decrease the number of sutures required for repair. This thereby reduces potential scarring and inflammation.

Clinical and patient reported outcomes using autologous fibrin sealant as adjunct to diode light amplification by stimulated emission of radiation‐assisted gingival depigmentation: A randomized controlled trial

AbstractBackgroundGingival depigmentation is quite an invasive procedure and often results in healing by secondary intention, postoperative morbidity, and repigmentation. Autologous fibrin sealant (AFS), a platelet concentrate commonly used due to its adhesive nature and presence of growth factors, has shown good clinical results and improved healing with anti‐inflammatory properties. Hence, the current study aims to evaluate clinical outcomes and patient reported outcomes (PROs) with the adjunctive use of AFS along with Diode light amplification by stimulated emission of radiation (LASER) in gingival depigmentation.MethodologyThis was a randomized double blinded split mouth clinical trial including 10 participants (six females and four males) in age range of 20 to 50 years with gingival hyperpigmentation (Dummet's index 2–3). Test (AFS) and control (no AFS [N‐AFS]) groups received Diode LASER depigmentation with and without adjunctive application of AFS, respectively, along with periodontal dressing. Clinical outcomes assessed were postoperative healing (Landry healing index) and repigmentation. PROs were patient comfort and aesthetics. Healing was assessed at 7 and 15 days and 1 month postoperatively. Repigmentation was assessed at 1, 3, and 6 months postoperatively. Patient comfort was assessed immediately after surgery and 1 week postoperatively using visual analog scale (VAS). Aesthetics was assessed at 1, 3, and 6 months postoperatively using VAS.ResultsBetter early postoperative healing was found at 1 (4.7 ± 0.516, p = 0.043) and 2 weeks (5.0 ± 0.0, p = 0.048) postoperatively in AFS group. No significant difference between the groups was observed in postoperative discomfort, that is, AFS‐1.4 ± 0.516 and N‐AFS‐1.7 ± 0.483 (p = 0.591), aesthetic satisfaction (AFS‐0.1 ± 0.316, N‐AFS‐0.3 ± 0.483, p = 0.168), and repigmentation (p = 0.00).ConclusionThe use of autologous fibrin sealant as adjunct to Diode LASER‐assisted depigmentation in the treatment of gingival pigmentation showed improved clinical outcomes in terms of postoperative healing.

Lateral Transorbital Endoscope-Assisted Resection of Anterior Temporal Lobe Neoplasm: 2-Dimensional Operative Video.

Transorbital neuroendoscopic surgery (TONES) is a minimally invasive approach, providing excellent access to extradural pathology of the sphenoid wing, orbital apex, Meckel's cave, and lateral cavernous sinus.1-10 Few cases of intradural pathology, such as gliomas or epileptic foci of the temporal lobe, have been described, apart from cadaveric anatomic studies.11-13 In this video, we present the case of a 63-year-old man with first time seizure. MRI demonstrated a fluid-attenuated inversion recovery hyperintense, noncontrast enhancing medial temporal lobe lesion consistent with low grade glioma. While frontotemporal craniotomy is the standard approach for this lesion, the TONES approach detailed in the video (the patient consented to the procedure and to the publication of his image) provided excellent access to the lesion, which minimized unnecessary trauma or removal of the lateral temporal lobe during the approach.4,14,15 The dura was closed primarily, overlayed with abdominal fat and fibrin glue, and a lumbar drain was left in place for 24 hours. The TONES approach avoided not only temporal lobe violation but also temporalis muscle disruption and any sort of external bone manipulation, which expedited the patient's recovery.16 The patient's eyelid incision was barely visible as early as postoperative day 7 with minimal ecchymosis. Postoperative MRI demonstrated a gross total resection. Pathology was consistent with a central nervous system World Health Organization grade 1 dysembryoplastic neuroepithelial tumor, a low-grade lesion with low risk of recurrence.17,18.

Autologous Concentrate Growth Factor for the Treatment of Endo-Perio Lesion – A Case Report

Abstract Introduction: The success of a combined periodontal and endodontic lesion depends on the elimination of both these disease processes. In the case of a combined endo-perio lesion, endodontic therapy results in healing of the endodontic component of involvement, while the prognosis of teeth would finally depend on the healing of the periodontal structure. Treatment: This case report evaluates the efficacy of autologous fibrin glue and bone graft, that is, sticky bone in the management of bone defects associated with endo-perio lesion. The endo-perio lesion is first treated endodontically, followed by periodontal therapy. Conclusion: The patient was kept on follow-up for 9 months, and satisfactory results in terms of bone fill and reduction in pocket depth were obtained. Take-away Lessons: The sticky bone enhances regeneration in treatment of endo-perio lesions.

Clinical and Optical Coherence Tomography Features of Subretinal Fibrin Glue after Glue-Assisted Vitrectomy for Rhegmatogenous Retinal Detachment Repair. GUARD Study – Report 3:

Purpose: To highlight the clinical and optical coherence tomography (OCT) features of subretinal fibrin glue and its resolution over time in patients who have undergone glue- assisted retinopexy for Rhegmatogenous Retinal Detachments (RRD). Methods: A report of 2 cases with subretinal migration of fibrin glue. Both the cases were assessed with clinical examination, serial fundus photos and serial OCT scans through the area of subretinal fibrin immediately after surgery, at 1 week, 2 weeks and at 6 weeks. Results: In both the cases of intraoperative subretinal glue migration during glue-assisted vitrectomy for RRD repair, the subretinal glue had a characteristic appearance and course of evolution. On examination and color photography, the glue had an amorphous whitish appearance with wispy edges. This corresponded to subretinal hyperreflective material (SHRM) on OCT with a layered appearance. By two weeks after surgery, the subretinal glue demonstrated substantial regression on retinal examination and on OCT scans. At 6 weeks visit, the entire glue was noted to be resorbed along with an intact photoreceptor outer segments/Ellipsoid Zone layer Conclusion: In summary, this report describes the clinical and OCT appearance of subretinal migration of fibrin glue. Subretinal fibrin appears whitish on examination and corresponds to layered SHRM without shadowing on OCT. It appears to resorb spontaneously within weeks with apparent recovery of the overlying photoreceptors.

Tensile strength of adhesives in peripheral nerve anastomoses: an in vitro biomechanical evaluation of four different neurorrhaphies

BackgroundThe fundamental prerequisite for prognostically favorable postoperative results of peripheral nerve repair is stable neurorrhaphy without interruption and gap formation.MethodsThis study evaluates 60 neurorrhaphies on femoral chicken nerves in terms of the procedure and the biomechanical properties. Sutured neurorrhaphies (n = 15) served as control and three sutureless adhesive-based nerve repair techniques: Fibrin glue (n = 15), Histoacryl glue (n = 15), and the novel polyurethane adhesive VIVO (n = 15). Tensile and elongation tests of neurorrhaphies were performed on a tensile testing machine at a displacement rate of 20 mm/min until failure. The maximum tensile force and elongation were recorded.ResultsAll adhesive-based neurorrhaphies were significant faster in preparation compared to sutured anastomoses (p < 0.001). Neurorrhaphies by sutured (102.8 [cN]; p < 0.001), Histoacryl (91.5 [cN]; p < 0.001) and VIVO (45.47 [cN]; p < 0.05) withstood significant higher longitudinal tensile forces compared to fibrin glue (10.55 [cN]). VIVO, with △L/L0 of 6.96 [%], showed significantly higher elongation (p < 0.001) compared to neurorrhaphy using fibrin glue.ConclusionWithin the limitations of an in vitro study the adhesive-based neurorrhaphy technique with VIVO and Histoacryl have the biomechanical potential to offer alternatives to sutured neuroanastomosis because of their stability, and faster handling. Further in vivo studies are required to evaluate functional outcomes and confirm safety.

PHARMACOLOGICAL INTERVENTIONS FOR THE PREVENTION OF BLEEDING IN PEOPLE UNDERGOING ELECTIVE HIP OR KNEE SURGERY: A COCHRANE SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS

Preoperative anaemia and intraoperative blood loss result in ∼90% of individuals being anaemic following hip and knee arthroplasty. Reducing blood loss offers the opportunity to improve outcomes and reduce the risk of transfusion and costs. This review's aim was to determine the effectiveness of drugs for preventing blood loss, and identify optimal dose, route, and timing of administration.Cochrane network meta-analysis of randomised controlled trials was conducted. Inclusion criteria: adults undergoing primary or revision elective hip or knee arthroplasty. Drugs studied: tranexamic acid (TXA), aprotinin, epsilon-aminocaproic acid, desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants, and non-fibrin sealants. Primary outcomes: need for allogenic blood transfusion, all• cause mortality (within 30 days). Secondary outcomes: mean number of transfusion episodes, re-operation, length of hospital stay and adverse events (DVT, PE, CVA, MI).102 studies with 8418 participants. Trials included more women (63%). 47 studies (4398 participants) were included within the blood transfusion NMA. TXA given intra-articularly and orally at a total dose of greater than 3g pre-incision, intraoperatively and postoperatively ranked the highest, with anticipated absolute effect of 147 fewer transfusions per 1000 (53% chance ranking 1st) (relative risk(RR) 0.02, 95% credible interval(CrI) 0–0.31); moderate-certainty). Aprotinin (RR 0.59, 95%:CrI 0.36–0.86; low certainty evidence), fibrin (RR 0.86, CrI 0.25–2.93; very-low certainty) and EACA (RR 0.60, 95%:CrI 0.29–1.27; very-low certainty) were not shown to be as effective as TXA.TXA was the most effective drug for preventing bleeding in lower limb arthroplasty. Aprotinin and EACA were not as effective. Currently, the optimal dose, route and timing of administration of TXA is unclear. However, TXA given at higher doses and via mixed routes ranked higher in the treatment hierarchy. Oral TXA may be as effective as intavenous. There was no evidence of harm associated with higher doses of TXA.

Maximum resistance pressure at the time of lung tissue rupture after porcine lung transection using automatic linear staplers with different reinforcement methods.

Polyglycolic acid (PGA) sheets, fibrin glue, and staple line reinforcement are frequently used to prevent air leakage during lung resection. However, the optimal staple-line reinforcement method remains unclear. Cranial lung lobes of pigs were used to evaluate different staple line reinforcement methods (n = 6). Ventilator-assisted manometry was used to measure the maximum resistance pressure at the time of rupture of the lung tissue after stapling. The mean maximum resistance pressures at the time of lung tissue rupture after using the stapler alone, stapler with PGA sheet and fibrin glue, and stapler with reinforcement were 38.0 cmH2O, 51.3 cmH2O, and 62.7 cmH2O, respectively. A significant increase in the maximum resistance pressure was observed with stapler reinforcement (P < 0.001), while the differences between the other groups were not statistically significant (P = 0.055, P = 0.111). A histological assessment revealed disruption of alveolar structures near the needle-stitching site in the stapler alone, and in the stapler with PGA sheet and fibrin glue groups. Pleural rupture near the staple line was observed in the stapler with reinforcement group. The maximum resistance pressure before air leakage was significantly higher when using a stapler with reinforcement than when using a stapler alone.

3D Lipogluing: Preliminary Results of a Novel Technique for Direct Three-dimensional Fat Grafting in Breast Reconstruction Surgery.

Lipofilling has emerged as an effective technique in breast reconstruction for enhancing aesthetic outcomes and addressing residual deformities. Traditionally, fat grafting has been performed as a secondary step in implant-based breast reconstruction during the replacement of the expander with a breast implant or as a revisional procedure. Our study investigates the technical feasibility and presents preliminary results of a new promising technique for delivering fat grafting in a three-dimensional (3D) shape, directly during mastectomy with immediate breast reconstruction or in delayed breast reconstructive procedures. Our new 3D lipogluing technique involves securing the fat tissue in a 3D manner using fibrin glue. This method enhances the coverage of soft tissues and provides improved volume and shape supplementation. In selected cases between December 2015 and September 2023, we treated 24 patients using the 3D lipogluing technique and five patients using 3D lipocubing (without use of fibrin glue).The patient cohort consisted of different indications for breast reconstructions: direct-to-implant, expander-based breast reconstruction, and "conservative" surgery. Preliminary findings suggest the technique is a safe and effective approach that can enhance the soft-tissue envelope of reconstructed breasts by acting as an autologous scaffold, owing to its regenerative properties. This technique not only improves the overall aesthetic outcome but also has the potential to reduce implant-related complications. Furthermore, ongoing studies are investigating methods to optimize the results and explore the potential application of 3D lipogluing and 3D lipocubing in breast-conserving oncoplastic surgery, cosmetic breast surgery, and other areas of plastic reconstructive and aesthetic surgery.

Overview of regulatory frameworks on the national lot release of plasma-derived medicinal products in Korea

Plasma-derived medicinal products (PDMPs) are essential in the treatment of acute and chronic life-threatening diseases. The Korea Ministry of Food and Drug Safety has conducted a national lot release (NLR) of PDMPs since 2012 based on a summary protocol review system and lot release testing. However, few studies have investigated the performance or characteristics of the NLR framework. Over the past decade, the NLR of PDMPs was approximately 1000 per year, including mainly albumins, immunoglobulins, fibrin sealant kits, and coagulation factors, among others. The NLR system for PDMPs is similar to that for vaccines, except that PDMPs are manufactured using human plasma, which requires strict safety management. This study describes the status of NLR procedures for PDMPs and outlines the regulatory requirements needed to safely manage plasma for fractionation in Korea. This study can aid national control laboratories and marketing authorization holders in developing regulatory systems that assure the availability of safe and effective PDMPs.

Endoscopic sealing hemostasis with polyglycolic acid sheet and fibrin glue as a novel endoscopic hemostatic technique: a report of three cases.

Polyglycolic acid sheets and fibrin glue are routinely used in surgical procedures. Their usefulness in gastrointestinal endoscopy is mainly to prevent complications (bleeding, delayed perforation, stenosis, etc.) associated with procedures such as endoscopic submucosal dissection and endoscopic mucosal resection, with most reports on iatrogenic and secondary conditions. However, there are few reports on primary gastrointestinal diseases. Herein, we report three cases of gastrointestinal bleeding that were successfully treated with endoscopic hemostasis by sealing the lesions with polyglycolic acid sheets and fibrin glue. Case 1 was of an 83-year-old woman with a rare duodenal perforation that was treated with omental plugging who experienced subsequent bleeding from the greater omentum. Case 2 was of a 73-year-old woman with an acute hemorrhagic rectal ulcer that was difficult to treat even after performing standard endoscopic hemostasis techniques; however, surgery was avoided by sealing. Case 3 was that of an 89-year-old woman with a stercoral ulcer, treated curatively using a combination of sealing and argon plasma coagulation right from presentation based on the lessons learned from Cases 1 and 2. Endoscopic hemostasis using a polyglycolic acid sheet and fibrin glue may be a new treatment option for gastrointestinal bleeding particularly in refractory or rare causes.

Combined superficial keratectomy, alcohol delamination and amniotic membrane patch with fibrin glue in Salzmann nodular degeneration.

To describe the outcomes of five Salzmann's Nodular Degeneration (SND) cases treated with a combination of alcohol delamination, superficial keratectomy and amniotic membrane patch with fibrin glue. Five patients affected by SND with significant discomfort and decreased visual acuity were evaluated with refraction, best corrected visual acuity, Break-up time test, corneal topography, Anterior Segment of Optical Coherence Tomography and images of anterior segment with a full slit lamp examination. All the patients underwent alcohol delamination of the corneal epithelium followed by superficial keratectomy to remove the subepithelial nodules. A patch of amniotic membrane was applied to all of them with a ring shape and a banana shape in two patients due to the location of the disease. A bandage contact lens was inserted. The patch was kept in place for 14 days. Another bandage contact lens was inserted for 21 days until the corneal epithelium had completely healed. The surgical procedure was successful in removing the nodules in all patients. Vision was restored in all cases with a significant regularization of the corneal surface and reduction of ocular discomfort. After a 12-month follow-up, none of the patients showed recurrence of the disease. Combining alcohol delamination with superficial keratectomy and amniotic membrane patch with fibrin glue is an effective procedure for the management of SND to regularize the corneal surface and avoid the recurrence of subsequent nodules. This report is the first description of the outcomes of SND cases treated with a combination of the aforementioned techniques.

Nerve Regeneration after a Nerve Graft in a Rat Model: The Effectiveness of Fibrin Glue

Background: Simulating the post-traumatic continuity defect of small human peripheral nerves, we compared the effectiveness of fibrin glue with neurorrhaphy for nerve gap restoration. Methods: In twenty-four male Wistar rats, a fifteen mm defect in one sciatic nerve only was made and immediately repaired with an inverted polarity autograft. According to the used technique, rats were divided into Group A (Control), using traditional neurorrhaphy, and Group B (Study), using fibrine glue sealing; in total, 50% of rats were sacrificed at 16 weeks and 50% at 21 weeks. Before sacrifice, an assessment of motor function was done through Walking Track Analysis and an electroneurophysiological evaluation. After sacrifice, selected muscle mass indexes and the histology of the regenerated nerves were assessed. All data were evaluated by Student’s t test for unpaired data. Results: No significant differences were found between the two groups, with only the exception of a relative improvement in the tibialis anterior muscle’s number of motor units in the study group. Conclusion: Despite the fact that the use of fibrin glue as a nerve sealant is not superior in terms of functional recovery, its effectiveness is comparable to that of microsurgical repair. Hence, the faster and technically easier glueing technique could deserve broader clinical application.

Glue-Assisted Retinopexy for Retinal Detachments Study Report 2: Fibrin Glue As a Surgical Adjunct in Complex Rhegmatogenous Retinal Detachment

Purpose: To present the successful application of fibrin glue as a surgical adjunct in the management of complex rhegmatogenous retinal detachment (RRD). Methods: In this retrospective case series, fibrin glue was used as a surgical adjunct in 5 cases of complex RRD. In each case, standard pars plana vitrectomy and laser retinopexy were performed by the same surgeon. Fibrin glue was used intraoperatively as a tamponade to seal the breaks because the isolated use of conventional tamponade agents was not feasible given the variable nature of the complex RRDs, the anatomy of the eye, or an inability to maintain postoperative positioning. Results: In 1 patient previously treated for a large corneoscleral tear, fibrin glue was used to seal a large iatrogenic retinal break caused by a fragmatome-related surge that led to a quadrantic RD. In 2 patients treated for combined RRD, fibrin glue was used with silicone oil to manage recurrent RRD with incompletely drained thick subretinal fluid and blood. In 2 other cases, fibrin glue was applied to manage RRD in congenital aniridia with advanced glaucoma and aphakia. In all cases, retinal attachment without serious adverse effects was attained over a follow-up ranging from 4 to 6 months. Conclusions: Fibrin glue is an effective, safe surgical adjunct in complex RRD. It can be used to transiently seal a retinal break when use of a conventional tamponade agent is not possible or not sufficient alone.

Symptomatic lumbar Tarlov cyst resolution after computed tomography-guided percutaneous trans-sacral fibrin glue intracystic injection: A case report and literature review

Symptomatic lumbar Tarlov cyst resolution after computed tomography-guided percutaneous trans-sacral fibrin glue intracystic injection: A case report and literature review

Posterior Transdural Repair of a Spontaneous Ventral Thoracic Cerebrospinal Fluid Leak: 2-Dimensional Operative Video.

Spontaneous intracranial hypotension is a rare but serious condition characterized by orthostatic headaches and a variety of neurological symptoms. 1,2 Spontaneous intracranial hypotension should be considered in all patients with new onset, daily, persistent headaches, and orthostatic symptoms. It is typically caused by spontaneous spinal cerebrospinal fluid (CSF) leaks. 1,2 Traditional first-line treatments include hydration, bedrest, epidural blood patches, and fibrin glue injections. However, refractory cases often require surgical intervention, especially those caused by a small ventral osteophyte, which is classified as a type 1 leak. 3-5 The small osteophyte causes a tear in the dura of the ventral canal, usually near the cervicothoracic junction. Diagnosis of these leaks is challenging because these small osteophytes can also occur asymptomatically, or patients may have several of them at multiple levels. Typically, dynamic myelography is needed for accurate localization due to the inadequacy of standard imaging. 6 This video details a young patient with refractory spontaneous intracranial hypotension from a type 1 spontaneous CSF leak, treated successfully using a posterior transdural surgical approach with spinal cord mobilization. Our video presentation outlines the surgical technique and provides an overview of this underdiagnosed condition. Our described approach offers direct visualization, suturing of the leak site, and a multilayer repair without the need for spinal fusion. It also avoids the morbidity to the neck, chest, and mediastinal structures that is at risk with lateral or anterior approaches. A combined intradural and extradural repair may enhance the durability of repair for ventral CSF leaks. The patient consented to the procedure. This operative video did not require Institutional Review Board approval as all patient information has been anonymized, ensuring no identifiable information is disclosed. The video is a single case that does not involve interventions or pose risks beyond standard care, adhering to ethical guidelines and institutional policies.

Application of Fibrin Sealant in the Treatment of Root Coverage Procedure - A Case Report

Application of Fibrin Sealant in the Treatment of Root Coverage Procedure - A Case Report

Fibrin glue mediated direct delivery of radiation sensitizers results in enhanced efficacy of radiation treatment

PurposeRadiation therapy (RT) plays an important role in the treatment of glioblastoma multiforme (GBM). However, inherent intrinsic resistance of tumors to radiation, coupled with the need to consider the tolerance of normal tissues and the potential effects on neurocognitive function, impose constraints on the amount of RT that can be safely delivered. A strategy for augmenting the effectiveness of RT involves the utilization of radiation sensitizers (RS). Directly implanting RS-loaded fibrin glue (FG) into the tumor resection cavity would by-pass the blood brain barrier, potentially enhancing the impact of RT on tumor recurrence. This study investigated the ability of FG to incorporate and release, in non-degraded form, the radiation sensitizers 5-Fluorouracil (5FU) and Motexafin gadolinium (MGd).MethodsFG layers were created in a 24-well plate by combining thrombin, fibrinogen, and 5FU or MGd. Supernatants from these layers were collected at various intervals and added to F98 glioma spheroid cultures in 96-well plates. Radiation was applied either before or after RS application as single or fractionated dosages. Spheroid growth was monitored for 14 days.ResultsCombined treatment of FG-released 5FU and RT significantly inhibited spheroid growth compared to RS or RT as a single treatment. As a free drug, MGd demonstrated its efficacy in reducing spheroid volume, but had diminished potency as a released RS. Fractionated radiation was more effective than single dose radiation.ConclusionNon-degraded RS was released from the FG for up to 72 h. FG-released 5FU greatly increased the efficacy of radiation therapy.