Document Detail

Dural repair with four spinal sealants: focused review of the manufacturers' inserts and the current literature.
MedLine Citation:
PMID:  21094467     Owner:  NLM     Status:  MEDLINE    
BACKGROUND CONTEXT: Deliberate or traumatic dural fistulas are typically augmented by a "sealant" or "fibrin glue" to enhance the strength of dural closure.
PURPOSE: Little is known about the risks and complications associated with two specific "sealants" and two specific "fibrin glues" used for dural closure.
STUDY DESIGN/SETTING: Review of the manufacturers' inserts and a focused review of the literature concerning the pros and cons for two "sealants" (DuraSeal [Confluent Surgical Inc., Waltham, MA, USA] and BioGlue [Cryolife, Kennesaw, GA, USA]) and two "fibrin glues" (EVICEL [Johnson and Johnson Wound Management, Ethicon Inc., Somerville, NJ, USA] and Tisseel [fibrin sealant; Baxter International Inc., Westlake Village, CA, USA]) were assessed.
PATIENT SAMPLE: A focused review of the literature using four different "sealants" or "fibrin glues" was performed.
OUTCOME MEASURES: Documentation of persistent/recurrent postoperative cerebrospinal fluid fistulas was an end point for failure for the four different "sealants" and "fibrin glues."
METHODS: Manufacturers' inserts and a focused review of the literature concerning the relative safety and efficacy of two "sealants" (DuraSeal and BioGlue) and two "fibrin glues" (EVICEL and Tisseel) used to augment dural closure were assessed.
RESULTS: Although DuraSeal is approved by the Federal Drug Administration (FDA) for intracranial and spinal application, two instances of paralysis are described in the literature. BioGlue is classified by the manufacturer as neurotoxic. EVICEL, one of the "fibrin glues," appeared in just two animal studies, whereas Tisseel, the other "fibrin glue," has been used in many large clinical series without adverse events.
CONCLUSION: Despite the lack of FDA approval, Tisseel (fibrin glue) has seen wide adoption in "off-label" use. DuraSeal, which is FDA approved, was associated with two instances of paralysis. Alternatively, BioGlue was described as neurotoxic even by the manufacturer.
Nancy E Epstein
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The spine journal : official journal of the North American Spine Society     Volume:  10     ISSN:  1878-1632     ISO Abbreviation:  Spine J     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-03-07     Revised Date:  2012-05-09    
Medline Journal Info:
Nlm Unique ID:  101130732     Medline TA:  Spine J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1065-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
The Leo M. Davidoff Department of Neurological Surgery, The Albert Einstein College of Medicine, Bronx 10461, NY, USA.
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MeSH Terms
Dura Mater / surgery*
Fibrin Tissue Adhesive / adverse effects,  therapeutic use
Proteins / adverse effects,  therapeutic use
Resins, Synthetic / adverse effects,  therapeutic use
Tissue Adhesives / adverse effects,  therapeutic use*
Reg. No./Substance:
0/Bio-glue; 0/Fibrin Tissue Adhesive; 0/Proteins; 0/Resins, Synthetic; 0/Tissue Adhesives; 80294-23-1/Dura-Seal
Comment In:
Spine J. 2011 Oct;11(10):983; author reply 983-4   [PMID:  22005082 ]
Spine J. 2012 Mar;12(3):279; author reply 280-1   [PMID:  22469306 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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