Turkish Neurosurgery 2019 , Vol 29 , Num 3
Identification of Risk Factors for Postoperative Cerebrospinal Fluid Leakage and Comparison of Two Alternative Dural Augmentation Techniques in Posterior Fossa and Spinal Surgeries
Muhammed Taha ESER1,Sahin HANALIOGLU1, Mehmet Ziya CETINER1,Samet DINC1,Halil Olgun PEKER2,Mehmet SORAR1,Habibullah DOLGUN1,Erhan TURKOGLU1
1Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey
2Health Sciences University, Istanbul Okmeydani Training and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
DOI : 10.5137/1019-5149.JTN.24432-18.0 AIM: To investigate comparative efficacy of a novel absorbable adhesive membrane (TissuePatchDuralTM “TPD”) and a fibrin glue (Tisseel “T”) in reducing cerebrospinal fluid (CSF) leaks after posterior fossa and spinal procedures, and also to identify potential risk factors for CSF leakage.

MATERIAL and METHODS: This is a single-center, retrospective cohort study of 123 consecutive posterior fossa (n=77) and spinal (n=46) surgeries. Patients were grouped based on dural sealants used 2-group comparison: TPD (n=56) vs. no-TPD (n=67) and 3-group comparison: T only (n=43), TPD only (n=32) vs TPD+T (n=35).

RESULTS: Mean age was 38.9 ± 22.2 years (62 males, 61 females). Baseline characteristics were similar between groups. Neither 2-group (TPD: 10.4% vs no-TPD: 8.9%; p=0.778) nor 3-group (T: 9.3% vs TPD: 6.3% vs TPD+T: 14.3%; p=0.539) comparisons revealed a significant difference in postoperative CSF leakage rates. Multivariate analysis showed that diagnosis (non-tumoral vs. tumor) (OR: 5.487; 95% CI: 1.118-26.937; p=0.036); previous surgery (OR: 9.268; 95% CI: 1.911-44.958; p=0.006), postoperative hydrocephalus (OR: 5.456; 95% CI: 1.250-23.821; p=0.024) were independent predictors of postoperative CSF leakage.

CONCLUSION: TissuePatchDuralTM is a novel dural sealant patch which can be safely used to reinforce dural closure in posterior fossa and spinal surgeries, and its efficacy is comparable to widely used fibrin glue (Tisseel). Non-tumoral pathologies, previous surgery, and postoperative hydrocephalus appear to be independent risk factors for postoperative CSF leakage. Keywords : Cerebrospinal fluid, Leakage, Dural sealant, Patch, Fibrin glue

Corresponding author : Erhan TURKOGLU, drmet122@yahoo.com