title: Study of dural suture watertightness: an in vitro comparison of different sealants.
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.
authors: Department of Neurosurgery, Groupe Hospitalier Pitié-Salpêtrière and Lariboisiere Hospital, 29 avenue Jean Moulin, 75014 Paris, France. dorianchauvet@yahoo.fr
authors: Dorian
authors: D
authors: Chauvet
authors: Viet
authors: V
authors: Tran
authors: Gurkan
authors: G
authors: Mutlu
authors: Bernard
authors: B
authors: George
authors: Jean-Marc
authors: JM
authors: Allain
mesh_terms: D002555:Cerebrospinal Fluid / Q000378:metabolism; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000517:prevention & control*; D004338:Drug Combinations; D004388:Dura Mater / Q000378:metabolism / Q000601:surgery*; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology; D005340:Fibrinogen / Q000494:pharmacology; D006801:Humans; D011312:Pressure; D011506:Proteins / Q000494:pharmacology; D012117:Resins, Synthetic / Q000494:pharmacology; D013536:Suture Techniques / Q000295:instrumentation; D013917:Thrombin / Q000494:pharmacology; D014014:Tissue Adhesives / Q000494:pharmacology*; D014867:Water / Q000378:metabolism
chemical_list: C472676:Bio-glue; D004338:Drug Combinations; D015718:Fibrin Tissue Adhesive; D011506:Proteins; D012117:Resins, Synthetic; C518955:TachoSil; D014014:Tissue Adhesives; D014867:Water; C030189:Dura-Seal; D005340:Fibrinogen; D013917:Thrombin