J Neurol Surg A Cent Eur Neurosurg 2017; 78(S 01): S1-S22
DOI: 10.1055/s-0037-1603847
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Georg Thieme Verlag KG Stuttgart · New York

The Optimal Dura Closure Technique and Material – An In-Vitro Evaluation

F. Ebel
1   Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
,
S. Wanderer
1   Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
,
J. Beck
1   Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
,
A. Raabe
1   Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
,
C.T. Ulrich
1   Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
› Author Affiliations
Further Information

Publication History

Publication Date:
02 June 2017 (online)

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Aim: To prevent a CSF leak and its complications a watertight dura closure is mandatory for intradural procedures.

A wide range of dura substitutes and closing techniques exists. Our aim was to evaluate, the best combination of material and technique to guarantee the best possible watertightness.

Methods: We developed an in vitro model (fluid chamber with dura insertion device, infusion pump, and pressure measurement) and used porcine pericardium as a dural equivalent. In our trial three different blocks of dural closure were tested. First, we verified suture-techniques (running and single-stich) as well as stich materials (6–0 Prolene®, 4–0 Biosyn® and 4–0 Polysorb®) by closing a 3 cm pericardium incision. Second, we applied different sealants (DuraSeal®, TachoSil™, Spongostan® + Tisseel®, Tisseel®, DuraGen Plus®, DuraGen secure® or Hemopatch®) additionally to a running suture with 6–0 Prolene®. Third, we applied different materials and techniques (Suturable DuraGen™ and Lyomesh Neuro® alone and in combination with a TachoSil™-Patch/”sandwich-technique”) for duraplasty on a 1.5 × 1.5 cm squared pericardium defect. After repeated evaluation of each material and technique we compared the hydrostatic pressure, at which first leakage appears through the closure. Statistical analysis was performed with Student’s t-test.

Results: Within the first block of the trial the 6–0 Prolene® suture had the highest leakage pressure (mean 5.75 cmH2O). There was no significant difference between the running and single-stich suture technique. The second block showed an increased leakage pressure for all sealants compared with solitary suture closure (2nd block mean 39.46 cmH2O versus 1st block mean 4.75 cmH2O). The highest leakage pressure for the linear incision was achieved by adding DuraSeal® or TachoSil™ to the 6–0 Prolene® suture (mean 77.6 cmH2O). In the third block, two sandwich-techniques (Suturable DuraGen™ with TachoSil™ or Lyomesh Neuro® with TachoSil™) were found to have the highest leakage pressure (mean 39.6 cmH2O) for the duraplasty.

Conclusion: In our in vitro model we achieved the highest leakage pressures for linear incision with 6–0 Prolene® running suture in combination with DuraSeal® or TachoSil™. The tightest duraplasty could be achieved with the “sandwich-techniques” (Suturable DuraGen™ and TachoSil™ or Lyomesh Neuro® and TachoSil™).