The Use Fibrin Sealant after Spinal Intradural Tumor Surgery: Is It Necessary?
OBJECTIVE
A fibrin sealant is commonly applied after closure of an incidental or intended durotomy to reduce the complications associated with the leakage of cerebrospinal fluid. Routine usage might not be essential after closure of an intended durotomy, which has clear cut-margins. We investigated the efficacy of fibrin sealants for primary intradural spinal cord tumor surgery.


METHODS
A retrospective review was performed for 231 consecutive surgically treated patients with primary intradural spinal cord tumors without extradural extension. Fibrin sealants were not used for 47 patients (group I: age, 51.57±16.75 years) and were applied to 184 patients (group II: age, 48.8±14.7 years). The surgical procedures were identical except for the use of a fibrin sealant after closure of the durotomy. The primary outcome was the occurrence of complications (wound problems, hematoma collection, infection, and neurological deterioration). The covariates were age, sex, body mass index, operation time, pre-/postoperative ambulation, number of laminectomies, and type of tumor.


RESULTS
Schwannoma was the most common pathology (n=134), followed by meningioma (n=35) and ependymoma (n=31). Complications occurred in 13 patients (3 in group I and 10 in group II, p=0.73). The postoperative ambulation status (p<0.01; odds ratio, 28.8; 95% confidence interval, 6.9-120.0) and operation time (p=0.04; cutoff, 229 minutes; sensitivity, 62%; specificity, 72%) were significant factors, whereas the use of a fibrin glue was not (p=0.47).


CONCLUSIONS
The use of a fibrin sealant might not be essential to reduce complications after surgery for primary spinal intradural tumor.
Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Young Il
YI
Won
Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
Chi Heon
CH
Kim
Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea.
Chun Kee
CK
Chung
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Tae-Ahn
TA
Jahng
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Department of Neurosurgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
Sung Bae
SB
Park
Cerebrospinal fluid; Fibrin tissue adhesive; Spinal cord neoplasms; Spine; Surgical wound infection