Comparison of dural closure methods for dural repair to reduce the incidence of cerebrospinal fluid leakage

Abstract

Purpose

Cerebrospinal fluid leakage (CSFL) is a common complication during spinal surgery. This study aimed to compare dural closure with different suture types, sizes, and techniques, and adhesives to reduce the occurrence of CSFL.

Materials and methods

Using a pig spine model, the PDS II 4-0, 5-0, 6-0, Vicryl 4-0, 5-0, 6-0, and Prolene 4-0, 5-0, 6-0 sutures were compared by calculating the permeability after suturing. Spraying bioprotein glue was also tried. Next, 120 patients who underwent surgery for intraspinal subdural tumors were enrolled and received 5-0 PDSII, Vicryl, or Prolene for dura repair.

Results

In the animal model study, Vicryl 5-0 showed a reduced leakage flow rate compared with 5-0 Prolene and 5-0 PDS II. In the clinical study, postoperative drainage in the Vicryl group was smaller than that in the other groups during the first 3 days after surgery (p < 0.05). Drainage volume of patients with postoperative cerebrospinal fluid leakage in the Vicryl group was smaller than that in the other groups during the first 3 days after surgery (p < 0.05). There were 12 patients (23.1%, 12/52) in the Vicryl group, 20 patients (55.6%, 20/36) in the PDS group, and 16 patients (50.0%, 16/32) in the Prolene group who had CSFL.The incidence of CSFL was significantly reduced in Vicryl group compared with the other groups(P < 0.05).

Conclusions

5-0 Vicryl sutures significantly reduced the dural leakage flow rate in an animal spine model. Fibrin glue can reinforce dural repair after surgery. 5-0 Vicryl was associated with a lower occurrence of CSFL in patients.

Keywords:

• Dural mater
• cerebral spinal fluid
• leakage
• fibrin glue
• intraspinal subdural tumors

Ethics approval and consent to participate

All animal experiments in this study were approved by the Institutional Animal Care and Use Committee of Taizhou Hospital of Zhejiang Province, China.

All participants provided informed consent for participation in the study, which was approved by the Medical Ethics Committee of Taizhou Hospital of Zhejiang Province. All patients provided written informed consent before surgery.

Disclosure statement

The authors have no conflicts of interest

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This study was funded by Medical Science and Technology Project of Zhejiang Province [2019RC307] and Medical Science and Technology Project of Zhejiang Province [2020KY1033].