World neurosurgery · 2026
Application-Dependent Early-Phase Stability of Autologous Fibrin Glue in Endoscopic Transsphenoidal Surgery.
СтатьяНазвание и аннотация: Перевод в очереди
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Suzuki Kohei, Nakano Yoshiteru, Yamaguchi Ayako, Inoue Masahiro, Yamamoto Junkoh
Аннотация
BACKGROUND: In endoscopic transsphenoidal surgery (eTSS), fibrin sealants are applied in a confined and frequently inclined operative field, where early-phase material behavior may influence sealant retention and procedural controllability before complete polymerization. Autologous fibrin glue is characterized by slower polymerization kinetics, which may influence its early-phase coagulation behavior immediately after application. However, the clinical relevance of this early-phase coagulation behavior and its association with application techniques remain unclear.
METHODS: We retrospectively analyzed 80 patients undergoing eTSS with skull base reconstruction (41 autologous, 39 allogeneic). In the autologous group, early-phase sealant behavior was assessed using intraoperative video analysis. Coagulation time was used as a practical video-assessable parameter of early-phase coagulation behavior rather than a direct measure of mechanical stability. The impact of application technique (spray vs. nozzle) was evaluated using multivariable linear regression. Clinical outcomes were compared between autologous and allogeneic groups.
RESULTS: Spray application significantly reduced coagulation time compared with nozzle application (8.0 [4.3] vs. 20 [12] seconds, P<0.001). Multivariable analysis identified spray delivery (β=-10.61, P<0.001) as an independent factor associated with shorter coagulation time. Despite these technical differences, postoperative cerebrospinal fluid leakage rates were comparable between groups (4.9% vs. 10%, P=0.426).
CONCLUSIONS: In eTSS, the early-phase coagulation behavior of autologous fibrin glue is strongly associated with application method. Spray delivery was associated with shorter coagulation time, suggesting that application technique may influence early-phase coagulation behavior in a confined operative field. These findings provide technical insight into fibrin glue behavior during reconstruction.
METHODS: We retrospectively analyzed 80 patients undergoing eTSS with skull base reconstruction (41 autologous, 39 allogeneic). In the autologous group, early-phase sealant behavior was assessed using intraoperative video analysis. Coagulation time was used as a practical video-assessable parameter of early-phase coagulation behavior rather than a direct measure of mechanical stability. The impact of application technique (spray vs. nozzle) was evaluated using multivariable linear regression. Clinical outcomes were compared between autologous and allogeneic groups.
RESULTS: Spray application significantly reduced coagulation time compared with nozzle application (8.0 [4.3] vs. 20 [12] seconds, P<0.001). Multivariable analysis identified spray delivery (β=-10.61, P<0.001) as an independent factor associated with shorter coagulation time. Despite these technical differences, postoperative cerebrospinal fluid leakage rates were comparable between groups (4.9% vs. 10%, P=0.426).
CONCLUSIONS: In eTSS, the early-phase coagulation behavior of autologous fibrin glue is strongly associated with application method. Spray delivery was associated with shorter coagulation time, suggesting that application technique may influence early-phase coagulation behavior in a confined operative field. These findings provide technical insight into fibrin glue behavior during reconstruction.