Effective Repair of Dural Tear Using Bioabsorbable Sheet With Fibrin Glue.

STUDY

DESIGN

Basic science.

OBJECTIVE

This study aimed to compare the techniques of surgical repair of dural tear using bioabsorbable material and fibrin glue.

SUMMARY OF BACKGROUND DATA: Cerebrospinal fluid (CSF) leakage caused by dural tear can often be difficult to manage even after repair when the same materials are used in a similar manner.

METHODS

Burst pressure was measured for repaired porcine dura with holes of different diameters using spray of combined fibrinogen and thrombin solution (fibrin spray) alone as a control and the 5-mm hole following different methods using fibrinogen and thrombin solutions plus polyglactin 910 sheet (PGS). For group 1, fibrinogen was applied on the dura followed by PGS and thrombin. For group 2, thrombin was followed by PGS and fibrinogen. For group 3, fibrinogen was followed by PGS and fibrin spray. For group 4, thrombin was followed by PGS and fibrin spray. Microscopic observation was conducted for each specimen.

RESULTS

Repair using fibrin spray alone was successful for the 0.3-mm diameter pinhole (breakdown pressure: 27.8 ± 8.6 mmHg), but was not able to cover the 2.7- and 5-mm holes. For a 5-mm diameter hole, the breakdown pressure was 54.4 ± 38.8 mmHg in group 1, 26.3 ± 19.4 mmHg in group 2, 147.7 ± 65.0 mmHg in group 3, and 35.5 ± 23.4 mmHg in group 4 (P < 0.001). There was little fibrin glue in the burst layer between the dural surface and PGS with thrombin on the dural surface (group 2 and group 4).

CONCLUSION

Suppression of excessive CSF leakage could be successful by performing several cycles of the group 1 method (fibrinogen was applied on the dura followed by PGS and thrombin), followed by the group 3 method (fibrinogen was applied on the dura followed by PGS and fibrin spray), with thrombin solution wash each time.

LEVEL OF EVIDENCE: 4.