title: Minimizing Collateral Brain Injury Using a Protective Layer of Fibrin Glue: Technical Note.
abstract: BACKGROUND
  Neurosurgical procedures expose the brain surface to a constant risk of collateral injury. We describe a technique where the brain surface is covered with a protective layer of fibrin glue and discuss its advantages.
  
  
  METHODS
  A thin layer of fibrin glue was applied on the brain surface after its exposure in 34 patients who underwent different craniotomies for tumoral and vascular lesions. Data of 35 more patients who underwent standard microsurgical technique were collected as a control group. Cortical and pial injuries were evaluated using an intraoperative visual scale. Eventual abnormal signals at the early postoperative T2-weighted fluid-attenuated inversion recovery (T2FLAIR) magnetic resonance imaging (MRI) sequences were evaluated in oncological patients.
  
  
  RESULTS
  Total pial injury was noted in 63% of cases where fibrin glue was not used. In cases where fibrin glue was applied, a significantly lower percentage of 26% (P < 0.01) had pial injuries. Only 9% had injuries in areas covered with fibrin glue (P < 0.0001). Early postoperative T2FLAIR MRI confirmed the differences of altered signal around the surgical field in the two populations.
  
  
  CONCLUSIONS
  We propose beside an appropriate and careful microsurgical technique the possible use of fibrin glue as alternative, safe, and helpful protection during complex microsurgical dissections. Its intrinsic features allow the neurosurgeon to minimize the cortical manipulation preventing minor collateral brain injury.
authors.affiliation: Arkansas Neuroscience Institute, St. Vincent's Infirmary Medical Center, Little Rock, Arkansas, USA.
authors.forename: Jaafar
authors.initials: J
authors.lastname: Basma
authors.affiliation: Arkansas Neuroscience Institute, St. Vincent's Infirmary Medical Center, Little Rock, Arkansas, USA; Department of Neuroscience, Neurosurgery, Uppsala University Hospital, Uppsala, Sweden; Department of Neuroscience and Rehabilitation, Division of Neurosurgery, S. Anna University Hospital, Ferrara, Italy. Electronic address: francesco.latini@neuro.uu.se.
authors.forename: Francesco
authors.initials: F
authors.lastname: Latini
authors.affiliation: Arkansas Neuroscience Institute, St. Vincent's Infirmary Medical Center, Little Rock, Arkansas, USA; Department of Neuroscience, Neurosurgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Ryttlefors
authors.affiliation: Arkansas Neuroscience Institute, St. Vincent's Infirmary Medical Center, Little Rock, Arkansas, USA.
authors.forename: Tarek
authors.initials: T
authors.lastname: Abuelem
authors.affiliation: Arkansas Neuroscience Institute, St. Vincent's Infirmary Medical Center, Little Rock, Arkansas, USA.
authors.forename: Ali Fadl
authors.initials: AF
authors.lastname: Krisht
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000453:epidemiology / Q000517:prevention & control*; D001932:Brain Neoplasms / Q000601:surgery; D002550:Cerebral Veins / Q000293:injuries; D002561:Cerebrovascular Disorders / Q000601:surgery; D003399:Craniotomy / Q000009:adverse effects; D005260:Female; D015718:Fibrin Tissue Adhesive; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D014014:Tissue Adhesives
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives
keywords: Brain retraction; Fibrin glue; Microsurgery; Surgically induced brain injury