Identification of risk factors for postoperative cerebrospinal fluid leakage and comparison of two alternative dural augmentation techniques in posterior fossa and spinal surgeries


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Eser M. T., Hanalioglu S., Cetiner M. Z., Dinc S., Peker H. O., SORAR M., ...More

Turkish Neurosurgery, vol.29, no.3, pp.377-385, 2019 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 29 Issue: 3
  • Publication Date: 2019
  • Doi Number: 10.5137/1019-5149.jtn.24432-18.0
  • Journal Name: Turkish Neurosurgery
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.377-385
  • Keywords: Cerebrospinal fluid, Leakage, Dural sealant, Patch, Fibrin glue, FIBRIN SEALANT, PREVENTION, BIOGLUE(R)
  • Lokman Hekim University Affiliated: Yes

Abstract

© 2019 Turkish Neurosurgical Society.AIM: To investigate comparative efficacy of a novel absorbable adhesive membrane (TissuePatchDuralTM "TPD") and a fibrin glue (Tisseel "T") in reducing cerebrospinal fluid (CSF) leaks after posterior fossa and spinal procedures, and also to identify potential risk factors for CSF leakage. MATERIAL and METHODS: This is a single-center, retrospective cohort study of 123 consecutive posterior fossa (n=77) and spinal (n=46) surgeries. Patients were grouped based on dural sealants used 2-group comparison: TPD (n=56) vs. no-TPD (n=67) and 3-group comparison: T only (n=43), TPD only (n=32) vs TPD+T (n=35). RESULTS: Mean age was 38.9 ± 22.2 years (62 males, 61 females). Baseline characteristics were similar between groups. Neither 2-group (TPD: 10.4% vs no-TPD: 8.9%; p=0.778) nor 3-group (T: 9.3% vs TPD: 6.3% vs TPD+T: 14.3%; p=0.539) comparisons revealed a significant difference in postoperative CSF leakage rates. Multivariate analysis showed that diagnosis (non-tumoral vs. tumor) (OR: 5.487; 95% CI: 1.118-26.937; p=0.036); previous surgery (OR: 9.268; 95% CI: 1.911-44.958; p=0.006), postoperative hydrocephalus (OR: 5.456; 95% CI: 1.250-23.821; p=0.024) were independent predictors of postoperative CSF leakage. CONCLUSION: TissuePatchDuralTM is a novel dural sealant patch which can be safely used to reinforce dural closure in posterior fossa and spinal surgeries, and its efficacy is comparable to widely used fibrin glue (Tisseel). Non-tumoral pathologies, previous surgery, and postoperative hydrocephalus appear to be independent risk factors for postoperative CSF leakage.