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Study of dural suture watertightness: an in vitro comparison of different sealants

Dorian Chauvet, Viet Tran, Gurkan Mutlu, Bernard George and Jean-Marc Allain

ACTA NEUROCHIRURGICA 153:12, 2465-2472, 2011 (DOI: 10.1007/s00701-011-1197-9)

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Abstract

Background 
CSF leakages constitute a major complication of intradural procedures, especially for posterior fossa and skull base surgery. Dural suture watertightness is a decisive issue, and neurosurgeons routinely use different products to reinforce their dural closure. We have designed an experimental system capable of testing CSF leak pressure levels in order to compare two types of sutures in vitro and particularly four different sealants.

Methods 
Twenty-five fresh human cadaveric dural samples were removed and prepared for testing in a pressure chamber system connected to a hydraulic pressure motor. CSF leak levels were objectively registered. First, simple interrupted stitches were compared to running simple closure on 50-mm linear suture. Secondly, four sealants (two sealants/glues, Bioglue®, Duraseal®; two haemostatics, Tachosil®, Tissucol®) were tested. Statistical analysis was performed with paired Student’s t-test.

Results 
No significant difference between interrupted closure and running suture was observed (p = 0.079). All sealants increased the watertightness of the suture significatively. However, comparison of the means of the differences for each product revealed large variations. In the conditions of our experiment, one sealant (Duraseal®) and one haemostatic (Tachosil®) seemed to show better results. We observed two different types of leakage: at the dura-sealant interface and through the sealant itself.

Conclusions 
We have developed an experimental device capable of testing dural closure watertightness. Interrupted stitch suturing seemed no different from running simple closure. On the contrary, the sealants tested show different watertightness capacities.

Keywords  Cerebrospinal fluid leakage – Dural suture – In vitro study – Sealants

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written by admin, December 25, 2011
Chauvet et al. have studied dural suture watertightness by in vitro comparison of different suture techniques and sealants. They conclude:

- no significant difference between interrupted simple stitches and running simple closure was found.

- all sealants increased the watertightness of the suture significatively.

- one sealant (Duraseal®) and one haemostatic (Tachosil®) seemed to show better results.

How do you close the dura in the posterior fossa? Only sutures? Sealants?

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