1. Study of dural suture watertightness: an in vitro comparison of different sealants
- Author
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Gurkan Mutlu, Dorian Chauvet, Bernard George, Jean-Marc Allain, Viet Samuel Tran, service de neurochirurgie, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire de mécanique des solides (LMS), École polytechnique (X)-MINES ParisTech - École nationale supérieure des mines de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [AP-HP], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
- Subjects
medicine.medical_specialty ,Leak ,Cerebrospinal Fluid Rhinorrhea ,Posterior fossa ,Fibrin Tissue Adhesive ,03 medical and health sciences ,0302 clinical medicine ,Suture (anatomy) ,Pressure ,otorhinolaryngologic diseases ,medicine ,Humans ,Major complication ,[PHYS.MECA.BIOM]Physics [physics]/Mechanics [physics]/Biomechanics [physics.med-ph] ,ComputingMilieux_MISCELLANEOUS ,Cerebrospinal Fluid ,Cerebrospinal Fluid Leak ,Cerebrospinal fluid leak ,medicine.diagnostic_test ,business.industry ,Suture Techniques ,Thrombin ,Fibrinogen ,Proteins ,Water ,Interventional radiology ,medicine.disease ,Surgery ,Drug Combinations ,Resins, Synthetic ,030220 oncology & carcinogenesis ,Skull base surgery ,Tissue Adhesives ,Dural closure ,Dura Mater ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
CSF leakages constitute a major complication of intradural procedures, especially for posterior fossa and skull base surgery. Dural suture watertightness is a decisive issue, and neurosurgeons routinely use different products to reinforce their dural closure. We have designed an experimental system capable of testing CSF leak 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. CSF leak 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 watertightness of the suture significatively. However, comparison of the means of the differences for each product revealed large variations. In the conditions of our experiment, one sealant (Duraseal®) and one haemostatic (Tachosil®) seemed to show better results. We observed two different types of leakage: at the dura-sealant interface and through the sealant itself.We have developed an experimental device capable of testing dural closure watertightness. Interrupted stitch suturing seemed no different from running simple closure. On the contrary, the sealants tested show different watertightness capacities.
- Published
- 2011
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