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Xu C, Zhao J, Gong Q, Chen S. Sustained release of vancomycin from bacterial cellulose membrane as dural substitutes for anti-inflammatory wound closure in rabbits. J Biomater Appl 2020; 34:1470-1478. [PMID: 32070189 DOI: 10.1177/0885328220908027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chen Xu
- Shanghai Sixth People's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Jianwei Zhao
- Shanghai Sixth People's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Qiuyuan Gong
- Shanghai Sixth People's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Shiwen Chen
- Shanghai Sixth People's Hospital, Shanghai JiaoTong University, Shanghai, China
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Steinmassl O, Laimer J, Offermanns V, Wildauer M, Steinmassl PA, Grams AE, Kofler F, Rasse M, Bruckmoser E. Clinical Outcome Following Surgical Repair of Small Versus Large Orbital Floor Fractures Using Polyglactin 910/Polydioxanone (Ethisorb ®). MATERIALS 2020; 13:ma13010206. [PMID: 31947782 PMCID: PMC6982172 DOI: 10.3390/ma13010206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 11/16/2022]
Abstract
The aim of this retrospective study was to evaluate the clinical outcome of surgical management of small versus large, isolated orbital floor fractures (OFFs) using polyglactin 910/polydioxanone (Ethisorb®). Covering a four-year period (2010-2013), all records concerning midfacial fractures with involvement of the orbit were screened. Isolated fractures of the orbital floor as well as combined injuries of the orbital floor and medial wall that had been treated surgically using polyglactin 910/polydioxanone (Ethisorb®) were included. Patients underwent a preoperative, a postoperative, and a late ophthalmologic assessment. The clinical outcomes of surgically managed small OFFs up to 2 cm2 were statistically analyzed and compared to clinical results in larger defects. The final sample included 61 patients (25 women, 36 men). Fractures up to 2 cm2 were found in 33 patients (54.1%), whereas 28 patients (45.9%) suffered from OFFs larger than 2 cm2. The clinical outcomes did not significantly differ between both sample categories, and statistical analysis showed a power of 0.91 to detect a potentially existing difference. On final examination, 52 patients were free of any clinical symptoms, whereas minor issues were found in seven subjects, and two patients suffered from severe impairment. In conclusion, polyglactin 910/polydioxanone (Ethisorb®) seems to be a suitable material for surgical repair of both small and large OFFs.
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Affiliation(s)
- Otto Steinmassl
- University Hospital for Cranio-Maxillofacial and Oral Surgery, A-6020 Innsbruck, Austria
| | - Johannes Laimer
- University Hospital for Cranio-Maxillofacial and Oral Surgery, A-6020 Innsbruck, Austria
- Correspondence: ; Tel.: +43-512-504-24271
| | - Vincent Offermanns
- University Hospital for Cranio-Maxillofacial and Oral Surgery, A-6020 Innsbruck, Austria
| | - Matthias Wildauer
- University Hospital for Radiology, Medical University of Innsbruck, A-6020 Innsbruck, Austria
| | | | - Astrid E. Grams
- University Hospital for Neuroradiology, A-6020 Innsbruck, Austria
| | - Ferdinand Kofler
- University Hospital for Cranio-Maxillofacial and Oral Surgery, A-6020 Innsbruck, Austria
| | - Michael Rasse
- University Hospital for Cranio-Maxillofacial and Oral Surgery, A-6020 Innsbruck, Austria
| | - Emanuel Bruckmoser
- Private Practice for Oral and Maxillofacial Surgery, A-5020 Salzburg, Austria
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George B, Matula C, Kihlström L, Ferrer E, Tetens V. Safety and Efficacy of TachoSil (Absorbable Fibrin Sealant Patch) Compared With Current Practice for the Prevention of Cerebrospinal Fluid Leaks in Patients Undergoing Skull Base Surgery: A Randomized Controlled Trial. Neurosurgery 2018; 80:847-853. [PMID: 28327892 DOI: 10.1093/neuros/nyx024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 01/18/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leakage associated with incomplete sealing of the dura mater is a major complication of intradural procedures. OBJECTIVE To compare the efficacy and safety of adjunctive TachoSil (Takeda Pharma A/S, Roskilde, Denmark) with current practice for the prevention of postoperative CSF leaks in patients undergoing elective skull base surgery involving dura mater closure. METHODS Patients were intraoperatively randomized to TachoSil or current practice immediately before primary dura closure by suturing ± duraplasty. Choice of adjunctive treatment in the current practice group was at the surgeon's discretion. Primary efficacy endpoint was occurrence of clinically evident verified postoperative CSF leak or clinically evident pseudomeningocele within 7 weeks after surgery or treatment failure (third application of trial treatment or use of other treatment). RESULTS A total of 726 patients were randomized to TachoSil (n = 361) or current practice (n = 365). More current practice patients had sutures plus duraplasty for primary dura closure compared with TachoSil (49.6% vs 35.7%) and fewer had sutures only (45.5% vs 63.2%). The primary endpoint of estimated leak rate favored TachoSil with events in 25 (6.9%) patients vs 30 (8.2%) current practice patients; however, this was not statistically significant (odds ratio: 0.82; 95% confidence interval: 0.47, 1.43; P = .485). Both treatments were well tolerated with similar frequency of adverse events. CONCLUSION Very low rates of postoperative CSF leaks can be achieved in patients undergoing skull base surgery of various indications. Although the study did not meet its primary endpoint, TachoSil appears to be safe and effective for the prevention of CSF leaks and associated complications.
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Affiliation(s)
- Bernard George
- Department of Neurosurgery, Hôpital Lariboisière, Paris, France
| | - Christian Matula
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Lars Kihlström
- Department of Clinical Neuroscience, Karolinska University Hospital, Stockholm, Sweden
| | - Enrique Ferrer
- Department of Neurosurgery, Hospital Clinic Barcelona, Barcelona, Spain
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Schiariti M, Acerbi F, Broggi M, Tringali G, Raggi A, Broggi G, Ferroli P. Two alternative dural sealing techniques in posterior fossa surgery: (Polylactide-co-glycolide) self-adhesive resorbable membrane versus polyethylene glycol hydrogel. Surg Neurol Int 2014; 5:171. [PMID: 25593755 PMCID: PMC4287912 DOI: 10.4103/2152-7806.146154] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 10/09/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Post-operative cerebrospinal fluid (CSF) leak in posterior fossa surgery remains a significant source of morbidity. TissuePatchDural (TPD), a novel impermeable adhesive membrane, was used to reinforce dural closure. A comparison with one of the most commonly used dural sealing devices, DuraSeal, has been made. METHODS A retrospective, single-center study was conducted on 161 patients who underwent elective posterior fossa surgery. On surgeon's opinion, when a primary watertight closure was not possible, they received TPD or DuraSeal to reinforce dural closure. RESULTS Out of 161 patients analyzed, 115 were treated with TPD and 46 with DuraSeal. The post-operative leaks related purely to TPD or DuraSeal failure were recognized in 3 (2.6%) and 5 (10.86%) cases, respectively (P = 0.015). The presence of pre- and post-operative risk factors was associated with an increased incidence of CSF leak in both groups. TPD showed a better control in patients without these risk factors (P = 0.08). The incidence of CSF leak in patients who underwent posterior fossa surgery by craniectomy was statistically lower in TPD group compared to DuraSeal group (3.22% vs 17.8%, respectively; P = 0.008). CONCLUSIONS TPD seems to be a safe tool for use as an adjunct to standard dural closure in posterior fossa surgery, particularly in patients without pre- or post-oper ative risk factors, in those who did not develop hydrocephalus, and who underwent craniectomy. The CSF leak rate in TPD group was found to be lower or within the range of the more advanced alternative dural closure strategies, including polyethylene glycol (PEG)-based sealant.
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Affiliation(s)
- Marco Schiariti
- Department of Neurosurgery, Public Health and Disability Unit, Fondazione Istituto Neurologico Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Public Health and Disability Unit, Fondazione Istituto Neurologico Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Public Health and Disability Unit, Fondazione Istituto Neurologico Besta, Milan, Italy
| | - Giovanni Tringali
- Department of Neurosurgery, Public Health and Disability Unit, Fondazione Istituto Neurologico Besta, Milan, Italy
| | - Alberto Raggi
- Department of Neurology, Public Health and Disability Unit, Fondazione Istituto Neurologico Besta, Milan, Italy
| | - Giovanni Broggi
- IRCCS Galeazzi, Centro Ricerche di Neuroscienze, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Public Health and Disability Unit, Fondazione Istituto Neurologico Besta, Milan, Italy
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Xu C, Ma X, Chen S, Tao M, Yuan L, Jing Y. Bacterial cellulose membranes used as artificial substitutes for dural defection in rabbits. Int J Mol Sci 2014; 15:10855-67. [PMID: 24937688 PMCID: PMC4100185 DOI: 10.3390/ijms150610855] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/22/2014] [Accepted: 06/03/2014] [Indexed: 12/03/2022] Open
Abstract
To improve the efficacy and safety of dural repair in neurosurgical procedures, a new dural material derived from bacterial cellulose (BC) was evaluated in a rabbit model with dural defects. We prepared artificial dura mater using bacterial cellulose which was incubated and fermented from Acetobacter xylinum. The dural defects of the rabbit model were repaired with BC membranes. All surgeries were performed under sodium pentobarbital anesthesia, and all efforts were made to minimize suffering. All animals were humanely euthanized by intravenous injection of phenobarbitone, at each time point, after the operation. Then, the histocompatibility and inflammatory effects of BC were examined by histological examination, real-time fluorescent quantitative polymerase chain reaction (PCR) and Western Blot. BC membranes evenly covered the surface of brain without adhesion. There were seldom inflammatory cells surrounding the membrane during the early postoperative period. The expression of inflammatory cytokines IL-1β, IL-6 and TNF-α as well as iNOS and COX-2 were lower in the BC group compared to the control group at 7, 14 and 21 days after implantation. BC can repair dural defects in rabbit and has a decreased inflammatory response compared to traditional materials. However, the long-term effects need to be validated in larger animals.
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Affiliation(s)
- Chen Xu
- Department of Neurosurgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai 200233, China.
| | - Xia Ma
- School of Perfume and Aroma Technology, Shanghai Institute of Technology, Haiquan Road 100, Shanghai 201418, China.
| | - Shiwen Chen
- Department of Neurosurgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai 200233, China.
| | - Meifeng Tao
- School of Life Sciences and Biotechnology, Shanghai Jiaotong University, Dongchuan Road 800, Shanghai 200240, China.
| | - Lutao Yuan
- Department of Neurosurgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai 200233, China.
| | - Yao Jing
- Department of Neurosurgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai 200233, China.
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Esmaeili A, Nejat F, Nouri M, Monajemzadeh M, El Khashab M. Unusual dural substitute complications in pediatric patients. Childs Nerv Syst 2012; 28:485-7. [PMID: 22246338 DOI: 10.1007/s00381-012-1679-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 01/02/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Arash Esmaeili
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Litvack ZN, West GA, Delashaw JB, Burchiel KJ, Anderson VC. Dural augmentation: part I-evaluation of collagen matrix allografts for dural defect after craniotomy. Neurosurgery 2009; 65:890-7; discussion 897. [PMID: 19834401 DOI: 10.1227/01.neu.0000356970.22315.bc] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Primary closure of the dura remains difficult in many neurosurgical cases. One option for dural grafting is the collagen sponge, which is available in multiple forms, namely, monolayer collagen and bilayer collagen. Our primary goal was to assess differences in the incidence of postoperative cerebrospinal fluid (CSF) leak, including fistula and pseudomeningocele, and postoperative infection between monolayer collagen and bilayer collagen grafts. METHODS A single-center retrospective analysis of 475 consecutive neurosurgical procedures was performed. Primary endpoints were CSF leak and infection, adjusting for the impact of additional nonautologous materials. Multivariate regression analysis was used to identify predictors of postoperative CSF leak and infection. RESULTS The overall frequency of postoperative CSF leak was 6.7%. There was no significant difference in the incidence of CSF leak based on the type of collagen sponge (monolayer versus bilayer) used (5.5% versus 7.5%, respectively; P = 0.38). The overall frequency of postoperative infection was 4.2%. There was no significant difference in the incidence of infection between groups (4.9% versus 3.8%; P = 0.54). Bilayer sponges were associated with a significantly lower incidence of CSF leak than monolayer sponges (odds ratio, 0.09; 95% confidence interval, 0.01-0.73). CONCLUSION Bilayer collagen sponges are associated with a reduction in postoperative CSF leak, notably in posterior fossa surgery. The need for additional non-native materials is predictive of postoperative CSF leak, along with location and type of procedure. Intrinsic patient characteristics (e.g., age, diabetes, smoking) do not seem to affect the efficacy of collagen sponge dural grafts.
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Affiliation(s)
- Zachary N Litvack
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
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