Toward optimal tissue sealants for neurosurgery: use of a novel hydrogel sealant in a canine durotomy repair model.
OBJECTIVE
Watertight dural repairs are difficult to achieve, and cerebrospinal fluid leakage causes complications and extends hospital stays. Therefore, a novel synthetic hydrogel film was evaluated as an adjunct to dural closure in a canine model.


METHODS
The self-polymerizing, absorbable, and biocompatible hydrogel was sprayed onto tissue and formed a flexible, adherent sealant. A 2-cm incision of cranial dura and arachnoid was created in 26 adult dogs and loosely repaired. Hydrogel was applied over the 2-mm dural gap in 13 dogs; 13 control dogs received no hydrogel application.


RESULTS
All dogs remained neurologically intact. Valsalva tests conducted at 1, 4, 7, and 56 days were associated with mean leakage pressures (+/- standard error of the mean) of 5 +/- 0, 5 +/- 0, 7 +/- 2, and 13 +/- 8 cm H(2)O in the controls and of 53 +/- 2, 37 +/- 11, 42 +/- 6, and 48 +/- 4 in the treated animals (P = 0.001, 0.053, 0.010, 0.035, respectively, at each time point; one-tailed t test). Histopathological analysis revealed minimal changes.


CONCLUSIONS
The hydrogel-treated animals exhibited normal progression of dural healing, no dural adhesions, and no underlying effects on the brain. Although dural healing progressed normally, the control animals displayed marked peridural adhesions. The results of this in vivo study suggest that hydrogels, such as that used here, may significantly decrease cerebrospinal fluid leakage, thereby increasing the safety and effectiveness of dural closure in patients and facilitating surgical reexploration.
Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. mpreul@chw.edu
Mark C
MC
Preul
William D
WD
Bichard
Robert F
RF
Spetzler
D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D004388:Dura Mater / Q000473:pathology / Q000601:surgery*; D008297:Male; D008756:Methylgalactosides / Q000627:therapeutic use*; D019635:Neurosurgical Procedures / Q000009:adverse effects; D013353:Subdural Effusion / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D014014:Tissue Adhesives / Q000627:therapeutic use*
D008756:Methylgalactosides; D014014:Tissue Adhesives; C109801:hydrogel film