A new porcine skull base model: fibrin glue improves strength of cerebrospinal fluid leak repairs.
OBJECTIVE
Fibrin glue is used in addition to grafts and flaps to repair cerebrospinal (CSF) leaks. We designed a porcine model to test the hypothesis that fibrin glue increases biomechanical strength.


METHODS
A randomized experimental animal study.


METHODS
Ten pigs underwent craniotomy with creation of a fistula through the cribriform plate into the nasal cavity. CSF leaks were endoscopically confirmed and repaired using pericranial grafts. The animals were randomized into a fibrin glue group (n=5) and a control group (n=5). Seven days later, endoscopic examination assessed for CSF leaks. The skull bases were harvested and examined for the degree of graft adherence (graded I-V) and subjected to burst pressure testing and histopathological analysis.


RESULTS
Eight animals survived, four in each group. There were no CSF leaks in the fibrin glue group and one in the control group. The fibrin glue group showed greater graft adherence (P=0.029) and higher burst pressures (13.8+/-5.4 vs 4.6+/-3.1 psi, P=0.021). Histopathological analysis revealed no difference in inflammation and bone remodeling.


CONCLUSIONS
The porcine model is a good model for anterior skull base defects. The model confirmed that fibrin glue reduces the rate of CSF leak by improving graft adherence and strength of repair.
de Almeida
John R
JR
Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada. john.dealmeida@utoronto.ca
Ghotme
Kemel
K
Leong
Iona
I
Drake
James
J
James
Adrian L
AL
Witterick
Ian J
IJ
D000818:Animals; D002559:Cerebrospinal Fluid Rhinorrhea / Q000188:drug therapy* / Q000601:surgery; D004195:Disease Models, Animal; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D007828:Laryngoscopy; D011897:Random Allocation; D019291:Skull Base / Q000601:surgery*; D013524:Surgical Flaps; D034421:Sus scrofa; D013552:Swine; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive