Autologous fibrin tissue adhesive for cerebrospinal fluid leaks: a controlled study of neurotoxicity.
Postoperative cerebrospinal fluid (CSF) leakage continues to be one of the most common and potentially serious complications following translabyrinthine surgery despite numerous strategies aimed at its prevention. Fibrinogen-based tissue adhesives may be helpful in decreasing this complication rate. Although commercial glues have been used widely in Europe (especially for dural repairs), they are not approved for use in the United States. Recent investigation has provided a relatively simple technique for producing a comparable autologous glue that obviates the risks of the commercial product. Since this glue will bind fascia, fat, and dura in the watertight fashion, it is potentially ideal for preventing CSF leaks. Experimental studies in rabbits reveal that autologous tissue adhesive can be used safely around intact nerves, suggesting it can be used safely to supplement fat, fascia, or muscle plugs for closing translabyrinthine defects. Clinical trials to test the efficacy of tissue adhesives in this application are currently under way.
Feldman
M D
MD
Department of Otolaryngology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
Sataloff
R T
RT
Ballas
S K
SK
D000818:Animals; D007611:Aprotinin / Q000633:toxicity*; D002555:Cerebrospinal Fluid; D004338:Drug Combinations / Q000633:toxicity; D007758:Ear, Inner / Q000601:surgery*; D005176:Factor XIII / Q000633:toxicity*; D015718:Fibrin Tissue Adhesive; D005340:Fibrinogen / Q000633:toxicity*; D008297:Male; D010525:Peripheral Nerves / Q000187:drug effects* / Q000648:ultrastructure; D011817:Rabbits; D013917:Thrombin / Q000633:toxicity*
D004338:Drug Combinations; D015718:Fibrin Tissue Adhesive; D005340:Fibrinogen; D005176:Factor XIII; D007611:Aprotinin; D013917:Thrombin