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J Neurol Surg A Cent Eur Neurosurg 2019; 80(01): 039-043
DOI: 10.1055/s-0038-1675565
Surgical Technique
Georg Thieme Verlag KG Stuttgart · New York

TachoSil Dural Reconstruction in Extracranial-Intracranial Bypass Surgeries

Julia Tews
1   Department of Neurosurgery, BG-Klinikum Bergmannstrost GmbH, Merseburger Straße 165, Halle 06112, Germany
,
Behnam Rezai Jahromi
2   Department of Neurosurgery, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
,
Christopher Ludtka
3   Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Stefan Schwan
4   Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Halle, Germany
,
Nakao Ota
5   Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
,
Hans Joerg Meisel
1   Department of Neurosurgery, BG-Klinikum Bergmannstrost GmbH, Merseburger Straße 165, Halle 06112, Germany
,
Rokuya Tanikawa
5   Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
,
Michael Lawton
6   Barrow Neurosurgical Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Felix Goehre
1   Department of Neurosurgery, BG-Klinikum Bergmannstrost GmbH, Merseburger Straße 165, Halle 06112, Germany
2   Department of Neurosurgery, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
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Publikationsverlauf

05. Dezember 2017

14. Mai 2018

Publikationsdatum:
15. November 2018 (online)

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Abstract

Background Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is a treatment option for hemodynamic insufficiency in the anterior cerebral circulation. Complications associated with extracranial-intracranial bypass surgeries are ischemic strokes caused by bypass failure, wound-healing disorders, and further issues from cerebrospinal fluid (CSF) leakage. CSF leakage can provide pathways for infection. It is well known in general neurosurgery that watertight closure of the dura mater is necessary to prevent such complications.

Objective To provide a technical description of TachoSil dural reconstruction in standard STA-MCA bypasses and their follow-up analyses.

Methods In this technical report with observational follow-up, the dura mater was closed partially by adaptive sutures, and the perforation site of the donor vessel was sealed with TachoSil. TachoSil is a collagen sponge covered with clotting factors that provides hemostatic and sealing effects.

Results Our study included eight cases of standard STA-MCA bypasses that had been operated between July 2015 and September 2016. Follow-up examinations were completed for all patients at 1 month and 6 months after surgery. Duplex and Doppler ultrasound demonstrated regular bypass patency in all patients without increased flow velocity at the perforation sites, which is a possible sign of stenosis. No wound-healing disorders or CSF leakage occurred. No cerebrovascular stroke events were observed.

Conclusion Duraplasty with TachoSil enables the elastic reconstruction of the dura perforation gap in standard extracranial-intracranial bypass surgeries.

Keywords

cerebral ischemia - dural closure - extracranial-intracranial bypass - STA-MCA bypass - TachoSil
 

  • References

  • 1 Gratzl O, Schmiedek P, Spetzler R, Steinhoff H, Marguth F. Clinical experience with extra-intracranial arterial anastomosis in 65 cases. J Neurosurg 1976; 44 (03) 313-324
    CrossrefPubMedSuche in Google Scholar
  • 2 Mehdorn HM. Cerebral revascularization by EC-IC bypass—present status. Acta Neurochir Suppl (Wien) 2008; 103: 73-77
    PubMedSuche in Google Scholar
  • 3 Rodríguez-Hernández A, Josephson SA, Lawton MT. Bypass surgery for the prevention of ischemic stroke: current indications and techniques. Neurocirugia (Astur) 2012; 23 (01) 5-14
    PubMedSuche in Google Scholar
  • 4 Vajkoczy P. Revival of extra-intracranial bypass surgery. Curr Opin Neurol 2009; 22 (01) 90-95
    CrossrefPubMedSuche in Google Scholar
  • 5 Yasargil MG. Microsurgery Applied to Neurosurgery. 6th ed. Stuttgart, Germany: Thieme; 2007: 105
    Suche in Google Scholar
  • 6 Abla AA, Gandhoke G, Clark JC. , et al. Surgical outcomes for moyamoya angiopathy at Barrow Neurological Institute with comparison of adult indirect encephaloduroarteriosynangiosis bypass, adult direct superficial temporal artery-to-middle cerebral artery bypass, and pediatric bypass: 154 revascularization surgeries in 140 affected hemispheres. Neurosurgery 2013; 73 (03) 430-439
    CrossrefPubMedSuche in Google Scholar
  • 7 Schubert GA, Biermann P, Weiss C. , et al. Risk profile in extracranial/intracranial bypass surgery—the role of antiplatelet agents, disease pathology, and surgical technique in 168 direct revascularization procedures. World Neurosurg 2014; 82 (05) 672-677
    CrossrefPubMedSuche in Google Scholar
  • 8 Spetzler RF, Schuster H, Roski RA. Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. J Neurosurg 1980; 53 (01) 22-27
    CrossrefPubMedSuche in Google Scholar
  • 9 Cosgrove GR, Delashaw JB, Grotenhuis JA. , et al. Safety and efficacy of a novel polyethylene glycol hydrogel sealant for watertight dural repair. J Neurosurg 2007; 106 (01) 52-58
    CrossrefPubMedSuche in Google Scholar
  • 10 Houkin K, Ishikawa T, Yoshimoto T, Abe H. Direct and indirect revascularization for moyamoya disease surgical techniques and peri-operative complications. Clin Neurol Neurosurg 1997; 99 (Suppl. 02) S142-S145
    PubMedSuche in Google Scholar
  • 11 Kim GW, Joo SP, Kim TS. , et al. Arachnoid membrane suturing for prevention of subdural fluid collection in extracranial-intracranial bypass surgery. J Cerebrovasc Endovasc Neurosurg 2014; 16 (02) 71-77
    CrossrefPubMedSuche in Google Scholar
  • 12 Kumar A, Maartens NF, Kaye AH. Evaluation of the use of BioGlue in neurosurgical procedures. J Clin Neurosci 2003; 10 (06) 661-664
    CrossrefPubMedSuche in Google Scholar
  • 13 Takanari K, Araki Y, Okamoto S. , et al. Operative wound-related complications after cranial revascularization surgeries. J Neurosurg 2015; 123 (05) 1145-1150
    CrossrefPubMedSuche in Google Scholar
  • 14 Sawamura Y, Asaoka K, Terasaka S, Tada M, Uchida T. Evaluation of application techniques of fibrin sealant to prevent cerebrospinal fluid leakage: a new device for the application of aerosolized fibrin glue. Neurosurgery 1999; 44 (02) 332-337
    CrossrefPubMedSuche in Google Scholar
  • 15 Nishimura K, Kimura T, Morita A. Watertight dural closure constructed with DuraSeal TM for bypass surgery. Neurol Med Chir (Tokyo) 2012; 52 (07) 521-524
    CrossrefPubMedSuche in Google Scholar
  • 16 Yoshimoto T, Sawamura Y, Houkin K, Abe H. Effectiveness of fibrin glue for preventing postoperative extradural fluid leakage. Neurol Med Chir (Tokyo) 1997; 37 (12) 886-889 ; discussion 889–890
    CrossrefPubMedSuche in Google Scholar
  • 17 Kivelev J, Göhre F, Niemelä M, Hernesniemi J. Experiences with TachoSil® in microneurosurgery. Acta Neurochir (Wien) 2015; 157 (08) 1353-1357 ; discussion 1357
    CrossrefPubMedSuche in Google Scholar
  • 18 Matula C, Steiger C. Hemostasis and Fleece-Bound Sealing in Neurosurgery. Stuttgart, Germany: Thieme; 2005
    Suche in Google Scholar
  • 19 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 2017; 80 (06) 847-853
    CrossrefPubMedSuche in Google Scholar
  • 20 Peña-Tapia PG, Kemmling A, Czabanka M, Vajkoczy P, Schmiedek P. Identification of the optimal cortical target point for extracranial-intracranial bypass surgery in patients with hemodynamic cerebrovascular insufficiency. J Neurosurg 2008; 108 (04) 655-661
    CrossrefPubMedSuche in Google Scholar
  • 21 Barth M, Tuettenberg J, Thomé C, Weiss C, Vajkoczy P, Schmiedek P. Watertight dural closure: is it necessary? A prospective randomized trial in patients with supratentorial craniotomies. Neurosurgery 2008; 63 (04) (Suppl. 02) 352-358 ; discussion 358
    CrossrefPubMedSuche in Google Scholar
  • 22 Nossek E, Langer DJ. How I do it: combined direct (STA-MCA) and indirect (EDAS) EC-IC bypass. Acta Neurochir (Wien) 2014; 156 (11) 2079-2084
    CrossrefPubMedSuche in Google Scholar
  • 23 Wanebo JE, Zabramski JM, Spetzler RF. Superficial temporal artery-to-middle cerebral artery bypass grafting for cerebral revascularization. Neurosurgery 2004; 55 (02) 395-398 ; discussion 398–399
    CrossrefPubMedSuche in Google Scholar
  • 24 Wintermantel E, Ha Suk-Woo. Medizintechnik mit biokompatiblen Werkstoffen und Verfahren. 3rd ed. Heidelberg, Germany: Springer; 2002: 190
    Suche in Google Scholar
  • 25 Genyk Y, Kato T, Pomposelli JJ. , et al. Fibrin sealant patch (TachoSil) vs oxidized regenerated cellulose patch (Surgicel original) for the secondary treatment of local bleeding in patients undergoing hepatic resection: a randomized controlled trial. J Am Coll Surg 2016; 222 (03) 261-268
    CrossrefPubMedSuche in Google Scholar
  • 26 Birth M, Figueras J, Bernardini S. , et al. Collagen fleece-bound fibrin sealant is not associated with an increased risk of thromboembolic events or major bleeding after its use for haemostasis in surgery: a prospective multicentre surveillance study. Patient Saf Surg 2009; 3 (01) 13
    CrossrefPubMedSuche in Google Scholar
  • 27 Colombo GL, Bettoni D, Di Matteo S. , et al. Economic and outcomes consequences of TachoSil®: a systematic review. Vasc Health Risk Manag 2014; 10: 569-575
    PubMedSuche in Google Scholar