A Novel Impermeable Adhesive Membrane to Reinforce Dural Closure: A Preliminary Retrospective Study on 119 Consecutive High-Risk Patients
A Novel Impermeable Adhesive Membrane to Reinforce Dural Closure: A Preliminary Retrospective Study on 119 Consecutive High-Risk Patients
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DOI：
10.1016/j.wneu.2011.09.022
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发表时间：
2013-03-01
影响因子：
2
通讯作者：
Broggi, Giovanni
中科院分区：
文献类型：
--
作者：
Ferroli, Paolo;Acerbi, Francesco;Broggi, Giovanni
目的：神经外科手术后脑脊液（CSF）漏仍然是发病率的重要来源。TissuePatchDural（TPD），一种新型的不渗透性粘合膜，可用于加强硬膜闭合的情况下，认为在高风险发展术后CSF leaks.METHODS：回顾性，单中心，临床研究进行了119例患者谁接受了择期神经外科手术1月至2010年6月。入选标准包括接受清洁择期手术的成人患者，其中无法进行初次水密性闭合。考虑了三组患者：1）幕下，67例; 2）幕上，34例; 3）脊柱，18例。所有患者均接受TPD加强硬脑膜闭合。术前（长期皮质类固醇治疗，以前的手术和放疗），术中（手术部位和硬脑膜间隙的大小），术后（早期和晚期脑积水）的条件进行了分析，可能与CSF leakage.Results相关的危险因素：平均随访时间为7.14个月（范围6-12个月）。119例中有11例（9.2%）检测到脑脊液漏。术前和术后危险因素的存在与脑脊液漏的百分比较高相关：22例病例中的8例（36.3%）vs. 97例病例中的3例（3.1%）（P < 0.0001）。所有泄漏均可保守治疗，无患者需要再次入院或二次手术。没有TPD相关的不良反应或过敏反应observed.CONCLUSIONS：TPD似乎是一种安全的工具，用于加强硬脑膜关闭的患者具有高风险的发展CSF泄漏。
OBJECTIVE: Postoperative cerebrospinal fluid (CSF) leak in neurosurgery remains a significant source of morbidity. TissuePatchDural (TPD), a novel impermeable adhesive membrane, can be used to reinforce dural closure in cases considered at high risk to develop postoperative CSF leak.METHODS: A retrospective, single-center, clinical investigation was conducted on 119 patients who underwent elective neurosurgical procedures between January and June 2010. Inclusion criteria included adult patients undergoing clean elective surgeries where a primary watertight closure was not possible. Three groups of patients were considered: 1) infratentorial, 67 cases; 2) supratentorial, 34 cases; and 3) spinal, 18 cases. All these patients received TPD to reinforce dural closure. Preoperative (long-term corticosteroid therapy, previous surgery and radiotherapy), intraoperative (site of procedures and size of dural gap), and postoperative (early and late hydrocephalus) conditions were analyzed as possible risk factors associated with CSF leakage.RESULTS: The mean follow-up was 7.14 months (range 6-12 months). CSF leak was detected in 11 of 119 cases (9.2%). The presence of pre- and postoperative risk factors was associated with a higher percentage of CSF leakage: 8 of 22 cases (36.3%) vs. 3 of 97 cases (3.1%) (P < 0.0001). All leaks could be conservatively treated and no patient required readmission or second surgery. No TPD-related adverse or allergic effects were observed.CONCLUSIONS: TPD seems to be a safe tool to be used to reinforce dural closure in patients with a high risk of developing CSF leaks.