Sinonasal outcomes associated with the use of BioGlue® in endoscopic transsphenoidal pituitary surgery

Concerns have been raised in the neurosurgical literature regarding the use of BioGlue®, a tissue sealant initially developed for cardiothoracic surgery, due to reports of an increased incidence of infection, wound breakdown, and CSF fistulae. The aim of this study was to determine if the use of BioGlue® in skull base repair impacts on the sinonasal outcomes and the incidence of post-operative infection following endoscopic pituitary surgery. SNOT-22 questionnaires were completed pre-operatively, and at 6, 12, and 24 weeks post-operatively by 50 patients. Pre- and post-operative MRI scans were reviewed and assessed for evidence of post-operative sinusitis. Patient records were consulted to ascertain the incidence of post-operative infection. Repeated measures ANOVA and Wilcoxon signed rank test were used for data analysis. Statistical analysis revealed a significant difference in the mean SNOT-22 scores across the four time intervals (F(1.605, 78.642) = 9.180, p = 0.001). This difference was powered by a deterioration at 6 weeks that recovered completely by 12 weeks. The mean SNOT-22 score in the study cohort at 24 weeks was 16.84/110 (range 0-57, ± 2.04) which was lower than the mean pre-operative score and is consistent with mild rhinosinusitis. There were no cases of post-operative meningitis and 1/50 (2%) case of post-operative sinusitis in this cohort. The use of BioGlue® in endoscopic endonasal pituitary surgery does not appear to lead to significant sinonasal morbidity. Previous concerns about the use of BioGlue® in transcranial procedures may not apply to extradural application of this tissue sealant in endoscopic transnasal surgery.

BioGlue® induced granuloma causing symptomatic spinal cord compression: a late complication

BioGlue® is an inert, bioadhesive surgical substance commonly used in spinal surgery to aid dural closure. The authors describe two cases in which the use of BioGlue® caused a local reaction culminating in the formation of a granuloma that caused cord compression several years after surgery in one case in which a second operation was required to relieve cord compression and remove the foreign material. In the other case spontaneous resolution occurred. To our knowledge these are the first reports of delayed spinal cord compression secondary to BioGlue®-induced granuloma. We recommend judicious use of this substance.

Does BioGlue contribute to anastomotic pseudoaneurysm after thoracic aortic surgery?

BACKGROUND

Although bovine serum albumin-glutaraldehyde glue (BioGlue®) has been successfully used as a hemostatic adjunct in aortic surgical procedures, there are reports that it may lead to anastomotic pseudoaneurysm formation. We seek to examine if the use of BioGlue is associated with a high incidence of anastomotic pseudoaneurysm formation following surgical repair of thoracic aortic disease.

METHODS

We reviewed the medical records and follow-up computed tomography (CT) scans of patients from 2001 to 2015 in whom BioGlue was used during surgical repair of thoracic aortic disease to detect postoperative anastomotic pseudoaneurysm formation.

RESULTS

A total of 233 patients with BioGlue use were identified. Mean age was 63.5±14.0 years (median 66; range 14-88; 25-75%, IQR 54-74 years) and 149 were male (63.9%). Surgical indication was thoracic aortic aneurysm in 169 (72.5%) patients, aortic dissection in 49 (21.0%), intramural hematoma in 9 (3.9%), penetrating aortic ulcer in 3 (1.3%) and other in 3 (1.3%). Emergency/urgent surgery was performed in 68 cases (29.2%). Operative mortality was 7.3% (17/233). Re-exploration for bleeding and neurologic deficits occurred in 24 (10.3%) and 21 (9.0%) patients respectively. All operative survivors were followed (100%, 216/216) and CT follow-up was available in 81.9% (177/216) for a mean duration of 2.4 years (median 0.6; 25-75% IQR 0.2-3.6 years). Anastomotic pseudoaneurysm was detected in 1 patient (0.6%) at 3 years postoperatively. This was an elderly female with extremely frail tissues who underwent a reoperative ascending and arch replacement for dissection.

CONCLUSIONS

The use of BioGlue in thoracic aortic surgery was not associated with excess incidence of anastomotic pseudoaneurysm formation following surgical repair of thoracic aortic disease. Its use need not be discouraged on this basis.

Bovine serum albumin-glutaraldehyde (BioGlue®) tissue adhesive versus standard renorrhaphy following renal mass enucleation: a retrospective comparison

BACKGROUND

To present the operative and post-operative comparison between patients who underwent tumor-bed closure with sutures compared with bovine serum albumin-glutaraldehyde (BioGlue^®) tissue sealant only.

METHODS

We retrospectively analyzed data from our ongoing database of 507 eligible patients who underwent open NSS nephron-sparing surgery in our department between January 1995 and May 2014. Patients had tumor-bed closure with sealant adhesive (255 patients) or standard suture technique (252 patients). Demographic, clinical and perioperative data were compared between the two groups, by Chi-square test or by Fisher-Irwin exact test for categorical variables, and by t test for differences in means or by Wilcoxon rank sum test for continuous variables. A multivariate analysis was also done.

RESULTS

Patients' baseline characteristics showed similar distribution of the analyzed parameters among both groups, with few differences: younger age in the sealant group (65.4 versus 68.4 years, p = 0.01) and slightly larger mass size in the suture group (4.0 versus 3.9 cm, p = 0.03). Ischemia time was significantly shorter in the sealant group (21.8 versus 27.0 minutes, p = 0001). Blood loss and transfusion rate (0.8% versus 11.9%, p = 0.0001) were significantly less in the sealant group. A multivariate analysis showed date of surgery and blood loss as the major parameters affecting transfusion rate.

CONCLUSIONS

Closing the tumor bed with BioGlue^® tissue adhesive is feasible, safe, can shorten ischemia time and potentially reduce transfusion rate.

BioGlue® coronary embolism during open heart surgery

In cases of iatrogenic coronary embolism during cardiac surgery or percutaneous coronary intervention, small air bubbles or foreign bodies are directly injected, which usually result in serious adverse events if not treated promptly. We herein describe the case of a patient who developed acute myocardial infarction resulting in shock due to BioGlue^® (CryoLife, Atlanta, GA, USA)-induced coronary embolism during the surgical repair of aortic dissection and was treated for retrieval of the material using a thrombectomy catheter. <Learning objective: Coronary embolism caused by surgical adhesives is a rare but potentially life-threatening complication. It is important for surgeons to promptly recognize and treat this serious condition in consultation with cardiologists.>.

The Use of a Bioadhesive (BioGlue(®)) Secured Conchal Graft and Mandibular Distraction Osteogenesis to Correct Pediatric Facial Asymmetry as Result of Unilateral Temporomandibular Joint Ankylosis

The rehabilitation of children affected by early traumatic facial deformity is a challenge for both the craniofacial team and the child's family. Although the immediate goals of surgery are to restore both form and function, the psychological needs of the growing child must also be addressed. Early surgery may be required to assist integration of the child into the community and thereby avert both social isolation and stigmatization of the child. Timed correctly, such surgery has the potential to harness the patient's own growth to assist in correction of the deformity and to maintain some of the surgical gains. The use of autogenous tissue rather than nondegradable implants to facilitate craniofacial reconstruction in the growing child avoids some of the concerns associated with permanent implants. These include both their potential to adversely affect growth and to migrate. The purpose of this article is to illustrate how advances in tissue adhesion using protein polymers (BioGlue(®); CryoLife, Inc., Kennesaw, GA) and bone regeneration techniques (distraction osteogenesis) have been used to correct the disfiguring and functional problems associated with unilateral temporomandibular joint ankylosis acquired in early childhood.