Toward Optimal Tissue Sealants for Neurosurgery

Use of a Novel Hydrogel Sealant in a Canine Durotomy Repair Model

Mark C. Preul, William D. Bichard, Timothy R. Muench, Robert F. Spetzler, Jeffrey N. Bruce, Robert G. Grossman, Laligam N. Sekhar, Dinko Stimac, Michael Y. Wang, Carl B. Heilman

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

OBJECTIVE: Watertight dural repairs are difficult to achieve, and cerebrospinal fluid leakage causes complications and extends hospital stays. Therefore, a novel synthetic hydrogel film was evaluated as an adjunct to dural closure in a canine model. METHODS: The self-polymerizing, absorbable, and biocompatible hydrogel was sprayed onto tissue and formed a flexible, adherent sealant. A 2-cm incision of cranial dura and arachnoid was created in 26 adult dogs and loosely repaired. Hydrogel was applied over the 2-mm dural gap in 13 dogs; 13 control dogs received no hydrogel application. RESULTS: All dogs remained neurologically intact. Valsalva tests conducted at 1, 4, 7, and 56 days were associated with mean leakage pressures (± standard error of the mean) of 5 ± 0, 5 ± 0, 7 ± 2, and 13 ± 8 cm H2O in the controls and of 53 ± 2, 37 ± 11, 42 ± 6, and 48 ± 4 in the treated animals (P = 0.001, 0.053, 0.010, 0.035, respectively, at each time point; one-tailed t test). Histopathological analysis revealed minimal changes. CONCLUSION: The hydrogel-treated animals exhibited normal progression of dural healing, no dural adhesions, and no underlying effects on the brain. Although dural healing progressed normally, the control animals displayed marked peridural adhesions. The results of this in vivo study suggest that hydrogels, such as that used here, may significantly decrease cerebrospinal fluid leakage, thereby increasing the safety and effectiveness of dural closure in patients and facilitating surgical reexploration.

Original languageEnglish
Pages (from-to)1189-1199
Number of pages11
JournalNeurosurgery
Volume53
Issue number5
StatePublished - Nov 1 2003
Externally publishedYes

Fingerprint

Hydrogel
Neurosurgery
Canidae
Dogs
Arachnoid
Hydrogels
Length of Stay
Safety
Pressure
Brain
Cerebrospinal Fluid Leak

Keywords

  • Cerebrospinal fluid leak
  • Dural repair
  • Dural seafant
  • Hydrogel

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Preul, M. C., Bichard, W. D., Muench, T. R., Spetzler, R. F., Bruce, J. N., Grossman, R. G., ... Heilman, C. B. (2003). Toward Optimal Tissue Sealants for Neurosurgery: Use of a Novel Hydrogel Sealant in a Canine Durotomy Repair Model. Neurosurgery, 53(5), 1189-1199.

Toward Optimal Tissue Sealants for Neurosurgery : Use of a Novel Hydrogel Sealant in a Canine Durotomy Repair Model. / Preul, Mark C.; Bichard, William D.; Muench, Timothy R.; Spetzler, Robert F.; Bruce, Jeffrey N.; Grossman, Robert G.; Sekhar, Laligam N.; Stimac, Dinko; Wang, Michael Y.; Heilman, Carl B.

In: Neurosurgery, Vol. 53, No. 5, 01.11.2003, p. 1189-1199.

Research output: Contribution to journalArticle

Preul, MC, Bichard, WD, Muench, TR, Spetzler, RF, Bruce, JN, Grossman, RG, Sekhar, LN, Stimac, D, Wang, MY & Heilman, CB 2003, 'Toward Optimal Tissue Sealants for Neurosurgery: Use of a Novel Hydrogel Sealant in a Canine Durotomy Repair Model', Neurosurgery, vol. 53, no. 5, pp. 1189-1199.
Preul MC, Bichard WD, Muench TR, Spetzler RF, Bruce JN, Grossman RG et al. Toward Optimal Tissue Sealants for Neurosurgery: Use of a Novel Hydrogel Sealant in a Canine Durotomy Repair Model. Neurosurgery. 2003 Nov 1;53(5):1189-1199.
Preul, Mark C. ; Bichard, William D. ; Muench, Timothy R. ; Spetzler, Robert F. ; Bruce, Jeffrey N. ; Grossman, Robert G. ; Sekhar, Laligam N. ; Stimac, Dinko ; Wang, Michael Y. ; Heilman, Carl B. / Toward Optimal Tissue Sealants for Neurosurgery : Use of a Novel Hydrogel Sealant in a Canine Durotomy Repair Model. In: Neurosurgery. 2003 ; Vol. 53, No. 5. pp. 1189-1199.
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N2 - OBJECTIVE: Watertight dural repairs are difficult to achieve, and cerebrospinal fluid leakage causes complications and extends hospital stays. Therefore, a novel synthetic hydrogel film was evaluated as an adjunct to dural closure in a canine model. METHODS: The self-polymerizing, absorbable, and biocompatible hydrogel was sprayed onto tissue and formed a flexible, adherent sealant. A 2-cm incision of cranial dura and arachnoid was created in 26 adult dogs and loosely repaired. Hydrogel was applied over the 2-mm dural gap in 13 dogs; 13 control dogs received no hydrogel application. RESULTS: All dogs remained neurologically intact. Valsalva tests conducted at 1, 4, 7, and 56 days were associated with mean leakage pressures (± standard error of the mean) of 5 ± 0, 5 ± 0, 7 ± 2, and 13 ± 8 cm H2O in the controls and of 53 ± 2, 37 ± 11, 42 ± 6, and 48 ± 4 in the treated animals (P = 0.001, 0.053, 0.010, 0.035, respectively, at each time point; one-tailed t test). Histopathological analysis revealed minimal changes. CONCLUSION: The hydrogel-treated animals exhibited normal progression of dural healing, no dural adhesions, and no underlying effects on the brain. Although dural healing progressed normally, the control animals displayed marked peridural adhesions. The results of this in vivo study suggest that hydrogels, such as that used here, may significantly decrease cerebrospinal fluid leakage, thereby increasing the safety and effectiveness of dural closure in patients and facilitating surgical reexploration.

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