title: Effectiveness of a new gelatin sealant system for dural closure.
abstract: OBJECTIVE
  Watertight dural closure is imperative after neurosurgical procedures because inadequately treated leakage of cerebrospinal fluid (CSF) can have serious consequences. In this study, the authors test the use of a new gelatin glue as a dural sealant in in vitro and in vivo canine models of transdural CSF leakage.
  
  
  METHODS
  The in vitro model was sutured semicircles of canine dura mater and artificial dural substitute. The sutures were sealed with gelatin glue (n  =  20), fibrin glue (n  =  20), or a polyethylene glycol (PEG)-based hydrogel sealant (n  =  20). Each sample was set in a device to measure water pressure, and pressure was increased until leakage occurred. Bonding strength was subjectively evaluated. The in vivo model was dogs who underwent dural excision and received either no sealant (control group; n  =  5) or gelatin glue sealant (n  =  5) before dural closure. Twenty-eight days post-surgery, the maximum intracranial pressure was measured at the cisterna magna using Valsalva maneuver and tissue adhesion was evaluated.
  
  
  RESULTS
  The water pressure at which leakage occurred in the in vitro model was higher with gelatin glue (76·5 ± 39·8 mmHg) than with fibrin glue (38·3 ± 27·4 mmHg, P < 0·001) or the PEG-based hydrogel sealant (46·3 ± 20·9 mmHg, P  =  0·007). Bonding strength was higher for the gelatin glue than fibrin glue (P < 0·001) or PEG-based hydrogel sealant (P  =  0·001). The maximum intracranial pressure in the in vivo model was higher for the gelatin glue group (59·0 ± 2·2 mmHg) than the control group (13·8 ± 4·0 mmHg, P < 0·001). Tissue adhesion was lower for the gelatin glue group than the control group (P  =  0·005).
  
  
  CONCLUSIONS
  The new gelatin glue provides an effective watertight closure when used as an adjunct to sutured dural repair.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kawai
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakagawa
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Nishimura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Motoyama
authors.forename: Young-Su
authors.initials: YS
authors.lastname: Park
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Nakamura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakase
authors.forename: Shuko
authors.initials: S
authors.lastname: Suzuki
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Ikada
mesh_terms: D000818:Animals; D001842:Bone and Bones / Q000473:pathology; D065634:Cerebrospinal Fluid Leak / Q000517:prevention & control; D004285:Dogs; D004388:Dura Mater / Q000473:pathology / Q000601:surgery*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005780:Gelatin / Q000627:therapeutic use*; D020100:Hydrogels / Q000627:therapeutic use; D007427:Intracranial Pressure; D019635:Neurosurgical Procedures / Q000379:methods; D010784:Photomicrography; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011312:Pressure; D011897:Random Allocation; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014867:Water
chemical_list: D015718:Fibrin Tissue Adhesive; D020100:Hydrogels; D014014:Tissue Adhesives; D014867:Water; D011092:Polyethylene Glycols; D005780:Gelatin
keywords: Cerebrospinal fluid leak,; Dural repair,; Dural sealant system,; Gelatin glue