Effectiveness of a new gelatin sealant system for dural closure

• Published in: Neurological research (New York) Vol. 36; no. 10; pp. 866 - 872
• Main Authors: Kawai, Hisashi, Nakagawa, Ichiro, Nishimura, Fumihiko, Motoyama, Yasushi, Park, Young-Su, Nakamura, Mitsutoshi, Nakase, Hiroyuki, Suzuki, Shuko, Ikada, Yoshito
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01-10-2014
• Subjects: Animals; Bone and Bones - pathology; Cerebrospinal fluid leak; Cerebrospinal Fluid Leak - prevention & control; Dogs; Dura Mater - pathology; Dura Mater - surgery; Dural repair; Dural sealant system; Fibrin Tissue Adhesive - therapeutic use; Gelatin - therapeutic use; Gelatin glue; Hydrogels - therapeutic use; Intracranial Pressure; Neurosurgical Procedures - methods; Photomicrography; Polyethylene Glycols - therapeutic use; Pressure; Random Allocation; Tissue Adhesives - therapeutic use; Water; Cerebrospinal fluid leak; Dural repair; Dural sealant system; Gelatin glue
• ISSN: 0161-6412; 1743-1328
• DOI: 10.1179/1743132814Y.0000000342

Objectives:
Watertight dural closure is imperative after neurosurgical procedures because inadequately treated leakage of cerebrospinal fluid (CSF) can have serious consequences. In this study, the authors test the use of a new gelatin glue as a dural sealant in in vitro and in vivo canine models of transdural CSF leakage.
Methods:
The in vitro model was sutured semicircles of canine dura mater and artificial dural substitute. The sutures were sealed with gelatin glue (n  =  20), fibrin glue (n  =  20), or a polyethylene glycol (PEG)-based hydrogel sealant (n  =  20). Each sample was set in a device to measure water pressure, and pressure was increased until leakage occurred. Bonding strength was subjectively evaluated. The in vivo model was dogs who underwent dural excision and received either no sealant (control group; n  =  5) or gelatin glue sealant (n  =  5) before dural closure. Twenty-eight days post-surgery, the maximum intracranial pressure was measured at the cisterna magna using Valsalva maneuver and tissue adhesion was evaluated.
Results:
The water pressure at which leakage occurred in the in vitro model was higher with gelatin glue (76·5 ± 39·8 mmHg) than with fibrin glue (38·3 ± 27·4 mmHg, P < 0·001) or the PEG-based hydrogel sealant (46·3 ± 20·9 mmHg, P  =  0·007). Bonding strength was higher for the gelatin glue than fibrin glue (P < 0·001) or PEG-based hydrogel sealant (P  =  0·001). The maximum intracranial pressure in the in vivo model was higher for the gelatin glue group (59·0 ± 2·2 mmHg) than the control group (13·8 ± 4·0 mmHg, P < 0·001). Tissue adhesion was lower for the gelatin glue group than the control group (P  =  0·005).
Discussion:
The new gelatin glue provides an effective watertight closure when used as an adjunct to sutured dural repair.