====== Hemopatch® ======

http://www.hemopatch.com/

Nowak et al., from [[Greifswald]], analyzed the results using Hemopatch® as a new [[dural sealant]] after [[durotomy]] in cranial and spinal [[neurosurgical procedure]]s.

In this [[prospective]] [[single center study]], they analyzed all patients who received Hemopatch® used as a [[dural sealant]] between October 2016 and May 2017. 34 patients received Hemopatch® used as a dural sealant in the study period. They included 23 (67.6%) female and 11 (32.3%) male patients. The mean age was 56 years (4-83 years). They included [[emergency]] and [[elective]] surgical [[procedure]]s as well as [[spinal]] and [[cranial]] [[intradural]] surgery. They did not exclude any type of underlying [[pathology]]. They took note of the general patient data, the size of Hemopatch® used, the type of [[dural closure]], and the postoperative [[stay]]. Additionally, they recorded the type of dural closure ([[watertight]]/ watertight with additional muscle patch/ not watertight with small or large defect (>1 cm) remaining) and of preoperative [[hydrocephalus]] as well as intraoperative [[ventricular]] opening.

Hemopatch® was used in addition to the following dural closures: 11 (32.4%) watertight [[suture]], 23 (67.6%) non-watertight suture. Three (8.8%) surgeries were emergency procedures. The site of surgery was as follows: 18 (52.9%) supratentorial, 16 (47.1%) infratentorial. A ventricular opening was performed in 13 (38.2%) cases. A hydrocephalus was present in 2 (5.9%) cases. A revision surgery after use of Hemopatch® was performed in 2 (5.9%) patients. Postoperative CSF fistulas and infections were observed in 2 patients each.

They could demonstrate the safety and efficiency of Hemopatch® used as dural sealant after durotomy in microneurosurgical procedures. To confirm our promising results a larger prospective randomized controlled trial will be needed
((Nowak S, Schroeder HWS, Fleck S. Hemopatch(®) as a new dural sealant: A
clinical observation. Clin Neurol Neurosurg. 2018 Dec 11;176:133-137. doi:
10.1016/j.clineuro.2018.12.009. [Epub ahead of print] PubMed PMID: 30557767.
))
----
[[Cerebrospinal fluid leakage]] occurs in 4% to 32% of cranial surgeries and is associated with significant patient burden and expense. The use of [[sealant]] as an adjunct to primary [[dural closure]] is assumed to help prevent CSF [[leakage]].

van Doormaal et al., evaluated 9 commonly used dural sealants, including [[Tachosil]] ([[Takeda]] Inc, Osaka, Japan), [[Adherus]] ([[Hyperbranch]] Inc, Durham, North Carolina), [[Duraform]] ([[Codman]], Raynham, Massachusetts), [[Tissudura]] ([[Baxter]], Deerfield, Illinois), [[Hemopatch]] (Baxter), [[TissuePatchDural]] ([[Tissuemed]], Leeds, United Kingdom), [[Tisseel]] (Baxter), [[Duragen]] Secure ([[Integra]], Plainsboro, New Jersey), and [[Duraseal]], (Integra). Sealants were tested in 2 novel in Vitro setups using fresh porcine dura: the first tested the acute burst pressure of a sealed 3-mm gap, while the second examined resistance to a pressure wave mimicking intracranial pressure for 72 h.

[[Adherus]] showed the highest mean burst pressure (87 ± 47 mmHg) followed by Tachosil (71 ± 16 mmHg) and Duraseal (51 ± 42 mmHg); these were the only 3 sealants showing burst pressures above normal physiological intracranial pressure. In the 72-h setup, only Adherus and Duraseal maintained appropriate sealing for the duration of the experiment. Tachosil released from the dura after 1.4 h (95% confidence interval, -1.8-4.7).

Given the high cost of sealants and the results of this study, they advocate a critical attitude toward sealant application as an adjunct to classic [[dural closure]]
((van Doormaal T, Kinaci A, van Thoor S, Redegeld S, Bergmann W, van der Zwan A.
Usefulness of Sealants for Dural Closure: Evaluation in an In Vitro Model. Oper
Neurosurg (Hagerstown). 2018 Oct 1;15(4):425-432. doi: 10.1093/ons/opx260. PubMed
PMID: 29281065.
)).

===== References =====