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A multicentre, prospective, randomized, controlled study to evaluate the use of a fibrin sealant as an adjunct to sutured dural repair

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Details

Original languageEnglish
Pages (from-to)11-17
Number of pages7
JournalBRITISH JOURNAL OF NEUROSURGERY
Volume29
Issue number1
DOIs
Publication statusPublished - 2015
Publication typeA1 Journal article-refereed

Abstract

Background. Obtaining intra-operative watertight closure of the dura is considered important in reducing post-operative cerebrospinal fluid (CSF) leak. The purpose of this study was to evaluate a fibrin sealant as an adjunct to sutured dural repair to obtain intra-operative watertight closure in cranial neurosurgery. Methods. This randomized, controlled multicenter study compared a fibrin sealant (EVICEL®Fibrin Sealant [Human]) to sutured dural closure (Control). Subjects underwent supratentorial or posterior fossa procedures. Following primary dural repair by sutures, the closure was evaluated for intra-operative CSF leak by moderately increasing the intracranial pressure. If present, subjects were randomized to EVICEL®or additional sutures (2:1 ratio), stratified by surgical approach. Following treatment, subjects were successful if no CSF leaks were present during provocative challenge. Safety was assessed to 30 days post-surgery, including incidence of CSF leakage. Results. One hundred and thirty-nine subjects were randomized: 89 to EVICEL®and 50 to Control. Intra-operative watertight closure was achieved in 92.1% EVICEL®-treated subjects versus 38.0% controls; a treatment difference of 54.1% (p <0.001). The treatment differences in the supratentorial and posterior fossa strata were 49.1% and 75.7%, respectively (p <0.001). The incidence of adverse events was similar between treatment groups. No deaths or unexpected serious adverse drug reactions were reported. CSF leakage within 30 days post-operatively was 2.2% and 2.0% in EVICEL®and control groups, respectively. In addition, 2 cases of CSF rhinorrhoea were observed in the EVICEL®group. Although not associated with the suture line where EVICEL®was applied, when combined with the other CSF leaks, the observed leak rate in the EVICEL®group was 4.5%. Conclusions. These results indicate that EVICEL®is effective as an adjunct to dural sutures to provide watertight closure of the dura mater in cranial surgery. The study confirmed the safety profile of EVICEL®.

ASJC Scopus subject areas

Keywords

  • Cerebrospinal fluid leak, Dural repair, Fibrin sealant, Watertight dural closure