Cerebrospinal fluid fistula requires exploration in the OR with Water-tight dural closure to prevent meningitis.
Water-tight dural closure is imperative after neurosurgical procedures because inadequately treated leakage of cerebrospinal fluid (CSF) can have serious consequences.
A standardized in vitro model helps to objectify the Water-tightness of dural closure. It allows testing of sutures and dural grafts alone or in combination. In the authors' testing, a running 6-0 monofilament polypropylene suture combined with DuraSeal or TachoSil was the technique achieving the highest BP. For the duraplasty of square defects, the double-layer technique showed the highest efficacy.
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When such a task cannot be performed, dural substitute and other adjunctive measures can provide an effective barrier between the subarachnoid compartment and the extradural space.
Cerebrospinal fluid fistulas constitute a major complication of intradural procedures, especially for posterior fossa and skull base surgery. Dural suture Water-tightness is a decisive issue, and neurosurgeons routinely use different products to reinforce their dural closure.
Chauvet et al. designed an experimental system capable of testing Cerebrospinal fluid fistula pressure levels in order to compare two types of sutures in vitro and particularly four different sealants.
Twenty-five fresh human cadaveric dural samples were removed and prepared for testing in a pressure chamber system connected to a hydraulic pressure motor. Cerebrospinal fluid fistula levels were objectively registered. First, simple interrupted stitches were compared to running simple closure on 50-mm linear suture. Secondly, four sealants (two sealants/glues, Bioglue®, Duraseal®; two haemostatics, Tachosil®, Tissucol®) were tested. Statistical analysis was performed with paired Student's t-test.
No significant difference between interrupted closure and running suture was observed (p = 0.079). All sealants increased the Water-tightness of the suture significatively. However, comparison of the means of the differences for each product revealed large variations. In the conditions of the experiment, one sealant (Duraseal®) and one haemostatic (Tachosil®) seemed to show better results. They observed two different types of leakage: at the dura-sealant interface and through the sealant itself.
They developed an experimental device capable of testing dural closure Water-tightness. Simple Interrupted stitch suturing seemed no different from running simple closure. On the contrary, the sealants tested show different Water-tightness capacities 1).
see Dural substitute.