Save
The optimal suture technique and subsitute for the dura closing: an in-vitro model
EANS Academy. Ebel F. 09/26/19; 276015; EP13013
Florian Marc Ebel
Florian Marc Ebel

Access to this content is reserved for EANS members and attendees of this event. Click here to become an EANS member and gain your access to the full content of the EANS Academy


Abstract
Discussion Forum (0)
Rate & Comment (0)
Background: A watertight dural closure after intradural procedures is required to prevent CSF leak and its complications. As there exist a various dura substitutes and closing techniques, our aim was to evaluate, the optimal combination of material and technique to achieve best watertightness.
Methods: An in vitro model (consisting of a fluid chamber, an infusion pump and a device for pressure measurement) with an incorporated porcine pericardium as dural equivalent was developed. In a first test block, different suture techniques (running and single-stich) and stich materials were tested to close an incision of 3 cm. In a second test block, different sealants additionally to a running suture were applied. Thirdly, we evaluated on a squared defect of 2.25 cm2 different dural substitutes for duraplasty as solitary layer or in combination double-layer combination (sandwich-technique). After repetitive evaluation of each combination, pressure at which leakage appears was measured. Statistical analysis was performed with Student's t-test.
Results: In the first test block, 6-0 Prolene running suture showed the highest leakage pressure (mean 5.75 cmH2O). There was no significant difference between the running and single-stich suture technique. The second test block demonstrated an increased leakage pressure for all sealants compared to solitary suture closure (mean 34.98 cmH2O versus mean 4.58 cmH2O). Within the second block, the highest leakage pressures was measured for DuraSeal or TachoSil additionally to a 6-0 Prolene suture (mean 82.3 & 74.17 cmH2O). Within the third block (duraplasty), a combination of suturable DuraGen with TachoSil or Lyomesh Neuro with TachoSil showed the highest leakage pressures (mean 37.17 & 43.67 cmH2O) for the squared dura defect.
Conclusion: Highest leakage pressures were achieved for linear incision with 6-0 Prolene running suture in combination with DuraSeal or TachoSil. Tightest duraplasty was performed with using suturable DuraGen and TachoSil or Lyomesh Neuro and TachoSil.
Background: A watertight dural closure after intradural procedures is required to prevent CSF leak and its complications. As there exist a various dura substitutes and closing techniques, our aim was to evaluate, the optimal combination of material and technique to achieve best watertightness.
Methods: An in vitro model (consisting of a fluid chamber, an infusion pump and a device for pressure measurement) with an incorporated porcine pericardium as dural equivalent was developed. In a first test block, different suture techniques (running and single-stich) and stich materials were tested to close an incision of 3 cm. In a second test block, different sealants additionally to a running suture were applied. Thirdly, we evaluated on a squared defect of 2.25 cm2 different dural substitutes for duraplasty as solitary layer or in combination double-layer combination (sandwich-technique). After repetitive evaluation of each combination, pressure at which leakage appears was measured. Statistical analysis was performed with Student's t-test.
Results: In the first test block, 6-0 Prolene running suture showed the highest leakage pressure (mean 5.75 cmH2O). There was no significant difference between the running and single-stich suture technique. The second test block demonstrated an increased leakage pressure for all sealants compared to solitary suture closure (mean 34.98 cmH2O versus mean 4.58 cmH2O). Within the second block, the highest leakage pressures was measured for DuraSeal or TachoSil additionally to a 6-0 Prolene suture (mean 82.3 & 74.17 cmH2O). Within the third block (duraplasty), a combination of suturable DuraGen with TachoSil or Lyomesh Neuro with TachoSil showed the highest leakage pressures (mean 37.17 & 43.67 cmH2O) for the squared dura defect.
Conclusion: Highest leakage pressures were achieved for linear incision with 6-0 Prolene running suture in combination with DuraSeal or TachoSil. Tightest duraplasty was performed with using suturable DuraGen and TachoSil or Lyomesh Neuro and TachoSil.
Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.



Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.


Save Settings