CLINICAL APPLICATION OF CYANOACRYLATES FOR PREVENTION OF CEREBROSPINAL FLUID LEAKAGE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YU Miao ¹ , JIANG Xiaobing ² , YAO Zhensong ² , ZHUANG Hong ² , LIANG De ² , DING Jinyong ² , ZHANG Shuncong ² , TANG Yongchao ² , XING Runlin ¹

1 Guangzhou University of Traditional Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;;
2 No.2 Department of Orthopedics, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. Corresponding author: YAO Zhensong, E-mail: yaozhensong@sina.com;

Corresponding author：

Keywords：

Cerebrospinal fluid leakage; Cyanoacrylate; Subdural tumor; Watertight closure

DOI：

10.7507/1002-1892.20130323

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Objective To explore the effectiveness of cyanoacrylates (Fuaile) for spinal subdural benign tumorectomy to prevent the cerebrospinal fluid leakage. Methods Between January 2009 and March 2013, 35 patients underwent spinal subdural benign tumorectomy. Of 35 patients, Fuaile and gelatin sponge were used after stitch suture for a watertight closure of the dura in 19 cases (trial group), and only gelatin sponge was used after stitch suture in 16 cases (control group). There was no significant difference in gender, age, disease duration, types of tumors, and sites of tumors between 2 groups (P gt; 0.05). The ratio of watertight closure, incision healing, and relative complications were compared between 2 groups. Results All patients in 2 groups achieved watertight closure of the dura intraoperatively. There was no significant difference in operation time, intraoperative blood loss, length of dura incision, hospitalization time, total drainage volume, and drainage time between 2 groups (P gt; 0.05). Primary incision healing was obtained; no delayed healing, infection, or nerve compression occurred in all patients. At last follow-up, the ratios of successful watertight closure of trial and control groups were 89.5% (17/19) and 50.0% (8/16) respectively, showing significant difference (P=0.02). No delayed cerebrospinal fluid leakage or incision infection was found at 1 and 3 months after operation. Conclusion The application of cyanoacrylates for watertight closure of dura in spinal subdural benign tumorectomy is safe and effective.

Citation： YU Miao,JIANG Xiaobing,YAO Zhensong,ZHUANG Hong,LIANG De,DING Jinyong,ZHANG Shuncong,TANG Yongchao,XING Runlin. CLINICAL APPLICATION OF CYANOACRYLATES FOR PREVENTION OF CEREBROSPINAL FLUID LEAKAGE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(12): 1471-1474. doi: 10.7507/1002-1892.20130323 Copy

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2.	Hirano K, Imagama S, Sato K, et al. Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study. Eur Spine J, 2012, 21(10): 2019-2026.
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4.	Conti P, Pansini G, Mouchaty H, et al. Spinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature. Surg Neurol, 2004, 61(1): 34-44.
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6.	Beall DP, Googe DJ, Emery RL, et al. Extramedullary intradural spinal tumors: a pictorial review. Curr Probl Diagn Radiol, 2007, 36(5): 185-198.
7.	Thomas A, Shetty AP, Rajasekaran S. Abducens nerve palsy associated with pseudomeningocele after lumbar disc surgery: a case report. Spine (Phila Pa 1976), 2012, 37(8): E511-513.
8.	程增银, 马文海, 崔建平, 等. 延长引流时间并间断夹闭引流管治疗脊柱术后脑脊液漏的疗效观察. 中国脊柱脊髓杂志, 2010, (12): 985-987.
9.	Wang JC, Bohlman HH, Riew KD. Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg (Am), 1998, 80(12): 1728-1732.
10.	Bosacco SJ, Gardner MJ, Guille JT. Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res, 2001, (389): 238-247.
11.	Kim KD, Wright NM. Polyethylene glycol hydrogel spinal sealant (DuraSeal Spinal Sealant) as an adjunct to sutured dural repair in thespine: results of a prospective, multicenter, randomized controlled study. Spine (Phila Pa 1976), 2011, 36(23): 1906-1912.
12.	Chauvet D, Tran V, Mutlu G, et al. Study of dural suture watertightness: an in vitro comparison of different sealants. Acta Neurochir (Wien), 2011, 153(12): 2465-2472.
13.	Narotam PK, Jose S, Nathoo N, et al. Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine (Phila Pa 1976), 2004, 29(24): 2861-2869.
14.	Kaufman BA, Matthews AE, Zwienenberg-Lee M, et al. Spinal dural closure with nonpenetrating titanium clips in pediatric neurosurgery. J Neurosurg Pediatr, 2010, 6(4): 359-363.
15.	Epstein NE. Dural repair with four spinal sealants: focused review of the manufacturers’ inserts and the current literature. Spine J, 2010, 10(12): 1065-1068.
16.	Jankowitz BT, Atteberry DS, Gerszten PC, et al. Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J, 2009, 18(8): 1169-1174.
17.	Feinberg EB, Funderburk R. Infectious disease risks of fibrin glue. Ophthalmic Surg, 1993, 24(3): 206.
18.	李伯清, 杨仲春. 2-氰基丙烯酸酯的制法及用途. 化工技术与开发, 2007, 36(3): 30-32.
19.	Ozisik PA, Inci S, Soylemezoglu F, et al. Comparative dural closure techniques: a safety study in rats. Surg Neurol, 2006, 65(1): 42-47.
20.	de Almeida Manzano RP, Naufal SC, Hida RY, et al. Antibacterial analysis in vitro of ethyl-cyanoacrylate against ocular pathogens. Cornea, 2006, 25(3): 350-351.
21.	Leggat PA, Smith DR, Kedjarune U. Surgical applications of cyanoacrylate adhesives: a review of toxicity. ANZ J Surg, 2007, 77(4): 209-213.
22.	Kitoh A, Arima Y, Nishigori C, et al. Tissue adhesive and postoperative allergic meningitis. Lancet, 2002, 359(9318): 1668-1670.
23.	Cohen-Gadol AA, Bellew MP, Akard W, et al. The application of n-butyl 2-cyanoacrylate to repair CSF fistulas for 221 patients who underwent transsphenoidal surgery. Mini Invasive Neurosurg, 2010, 53(4): 207-209.

1. Khan MH, Rihn J, Steele G, et al. Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976), 2006, 31(22): 2609-2613.
2. Hirano K, Imagama S, Sato K, et al. Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study. Eur Spine J, 2012, 21(10): 2019-2026.
3. Grimm S, Chamberlain MC. Adult primary spinal cord tumors. Expert Rev Neurother, 2009, 9(10): 1487-1495.
4. Conti P, Pansini G, Mouchaty H, et al. Spinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature. Surg Neurol, 2004, 61(1): 34-44.
5. Iacoangeli M, Gladi M, Di Rienzo A, et al. Minimally invasive surgery for benign intradural extramedullary spinal meningiomas: experience of a single institution in a cohort of elderly patients and review of the literature. Clin Interv Aging, 2012, 7: 557-564.
6. Beall DP, Googe DJ, Emery RL, et al. Extramedullary intradural spinal tumors: a pictorial review. Curr Probl Diagn Radiol, 2007, 36(5): 185-198.
7. Thomas A, Shetty AP, Rajasekaran S. Abducens nerve palsy associated with pseudomeningocele after lumbar disc surgery: a case report. Spine (Phila Pa 1976), 2012, 37(8): E511-513.
8. 程增银, 马文海, 崔建平, 等. 延长引流时间并间断夹闭引流管治疗脊柱术后脑脊液漏的疗效观察. 中国脊柱脊髓杂志, 2010, (12): 985-987.
9. Wang JC, Bohlman HH, Riew KD. Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg (Am), 1998, 80(12): 1728-1732.
10. Bosacco SJ, Gardner MJ, Guille JT. Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res, 2001, (389): 238-247.
11. Kim KD, Wright NM. Polyethylene glycol hydrogel spinal sealant (DuraSeal Spinal Sealant) as an adjunct to sutured dural repair in thespine: results of a prospective, multicenter, randomized controlled study. Spine (Phila Pa 1976), 2011, 36(23): 1906-1912.
12. Chauvet D, Tran V, Mutlu G, et al. Study of dural suture watertightness: an in vitro comparison of different sealants. Acta Neurochir (Wien), 2011, 153(12): 2465-2472.
13. Narotam PK, Jose S, Nathoo N, et al. Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine (Phila Pa 1976), 2004, 29(24): 2861-2869.
14. Kaufman BA, Matthews AE, Zwienenberg-Lee M, et al. Spinal dural closure with nonpenetrating titanium clips in pediatric neurosurgery. J Neurosurg Pediatr, 2010, 6(4): 359-363.
15. Epstein NE. Dural repair with four spinal sealants: focused review of the manufacturers’ inserts and the current literature. Spine J, 2010, 10(12): 1065-1068.
16. Jankowitz BT, Atteberry DS, Gerszten PC, et al. Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J, 2009, 18(8): 1169-1174.
17. Feinberg EB, Funderburk R. Infectious disease risks of fibrin glue. Ophthalmic Surg, 1993, 24(3): 206.
18. 李伯清, 杨仲春. 2-氰基丙烯酸酯的制法及用途. 化工技术与开发, 2007, 36(3): 30-32.
19. Ozisik PA, Inci S, Soylemezoglu F, et al. Comparative dural closure techniques: a safety study in rats. Surg Neurol, 2006, 65(1): 42-47.
20. de Almeida Manzano RP, Naufal SC, Hida RY, et al. Antibacterial analysis in vitro of ethyl-cyanoacrylate against ocular pathogens. Cornea, 2006, 25(3): 350-351.
21. Leggat PA, Smith DR, Kedjarune U. Surgical applications of cyanoacrylate adhesives: a review of toxicity. ANZ J Surg, 2007, 77(4): 209-213.
22. Kitoh A, Arima Y, Nishigori C, et al. Tissue adhesive and postoperative allergic meningitis. Lancet, 2002, 359(9318): 1668-1670.
23. Cohen-Gadol AA, Bellew MP, Akard W, et al. The application of n-butyl 2-cyanoacrylate to repair CSF fistulas for 221 patients who underwent transsphenoidal surgery. Mini Invasive Neurosurg, 2010, 53(4): 207-209.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL APPLICATION OF CYANOACRYLATES FOR PREVENTION OF CEREBROSPINAL FLUID LEAKAGE

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