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Optimization of watertight spinal dural sealing
EANS Academy. Kinaci A. Sep 27, 2019; 276056; EP11010
Abstract
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Background: Cerebrospinal fluid (CSF) leakage is a complication after spinal surgery that can occur following intradural surgery or because of an unintended durotomy.
In this study, we tested the performance of current dural sealants in an in vitro spinal model and aimed to develop an optimal dural sealing with a Dural Sealant Patch (DSP).
Methods: Four currently used spinal sealants (one fibrin glue, one fibrin patch and two polyethylene glycol hydrogels from different manufacturers (sealant A and B)) were tested in two in vitro spinal setups using spinal porcine dura. In setup one, the sealants were applied on a 3mm long midline incision in the dura (n=14 for each sealant) that was placed in an acute burst pressure spinal model. In setup two, the chronic resistance of each sealant was tested by mimicking the intraspinal pressure wave (range 50-65mmHg), the temperature (37ºC) and the humid conditions (artificial CSF) for 48 hours. The DSP was assessed in the same setups. Subsequently, the performance and biocompatibility of the DSP was studied in an in vivo porcine model.
Results: Only one sealant had a mean burst pressure below the intraspinal pressure (Fig 1). The mean burst pressure of DSP was higher than all dural sealants (p< 0.05), except compared to polyethylene glycol hydrogel sealant (sealant A). All sealants of DSP and polyethylene glycol hydrogel (sealant B) maintained attached in the chronic resistance test.The interim analyses (n=8) of the in vivo study showed good adherence and acute sealing properties of DSP. However, the model showed technical difficulties because of extreme vulnerability of the porcine myelum.
Conclusion: There is a tendency that DSP application results in better spinal dural sealing. However, the in vivo study has to be expanded before clinical studies can be performed.


[Figure 1. Boxplot showing the mean burst pressure for each sealant.]

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