J Neurol Surg B Skull Base 2019; 80(S 01): S1-S244
DOI: 10.1055/s-0039-1679776
Poster Presentations
Georg Thieme Verlag KG Stuttgart · New York

in Endoscopic Endonasal Skull Base Reconstruction

Zachary Cappello
1   Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Christopher Roxbury
1   Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Janki Shah
1   Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Troy Woodard
1   Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Varun R. Kshettry
2   Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, United States
,
Pablo F. Recinos
2   Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, United States
,
Raj Sindwani
1   Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
06 February 2019 (online)

 

Objectives: Cerebrospinal fluid (CSF) leak is the most common complication of endoscopic endonasal skull base surgery. Given an inability to secure grafts with sutures, endoscopic skull base surgeons often utilize a variety of dural sealants to augment multi-layered skull base reconstructions. Dural sealants can fail when they cannot resist physiologic burst pressure for an adequate healing time period. In addition, suboptimal application due to the effects of gravity can also lead to failure. The objective of this study was to describe the initial experience with a novel autospray dural sealant (Adherus, Hyperbranch Medical, Inc, Durham, NC) in a tertiary endoscopic skull base surgery practice and compare its effectiveness and postoperative morbidity (synechiae, scarring, need for antibiotics, need for additional postoperative debridement) to previously used sealants.

Design: The first 35 consecutive cases in which autospray dural sealant was utilized were reviewed. These patients were then compared with 35 prior patients in which standard dural sealants (Tisseel, Baxter Medical Inc, Deerfield, IL) or Duraseal (Integra LifeSciences Corp, Plainsboro, NJ) were employed. The primary endpoints evaluated were presence of a postoperative CSF leak, the number of postoperative debridements, and the need for postoperative antibiotics. Each component was analyzed individually using the two-sided Fisher’s exact test.

Results: The mean age of subjects was 56.7 years (range: 17–88 years) and 51.4% were females. There were no significant differences between the autospray sealant and the traditional dural sealant groups in terms of age, gender, surgical approach, or reconstruction type. There were a total of 2 postoperative CSF leaks (5.7%) in each arm of the study. There were no significant differences between the 2 arms with regard to need for additional postoperative debridements, or need for antibiotics (p > 0.05). Patients undergoing multiple debridements were more likely to be treated with antibiotics (37.5 vs. 7.4%, p = 0.01).

Conclusion: Autospray dural sealant is safe and effectively achieves a watertight reconstruction in endoscopic endonasal skull base surgery. Our preliminary findings suggest that it is equivalent to traditional sealants in outcome, and may provide a more precise application