Localized controlled fibrin glue application with gelatin sponge for hemostasis and dural defect repair: Technical note

Abstract

Objectives: Hemostasis and dural defect repair are fundamental aspects of neurosurgical procedures. Some significant bleeding may be caused by dural tears (e.g. bleeding from cerebral dural venous sinuses). Various methods have been previously reported for these purposes, utilizing commercially available surgical materials such as gelatin sponge and fibrin glue. We describe a simple, yet versatile and flexible technique with a critical modification to the previously known combined use of gelatin sponge and fibrin glue. We then present a few illustrative cases and discuss the utility and advantages of the described technique. Patients and methods: The described technique involves separate and sequential application of fibrinogen solution followed by thrombin solution of fibrin glue over gelatin sponge, which enables hemostasis or dural defect repair in a localized, controlled manner. Results: We have utilized this technique effectively for hemostasis and dural defect repair in a variety of neurosurgical procedures for over 10 years. We have found the technique to be highly useful and effective, although the effectiveness of this technique may be difficult to quantify objectively and independently of the other standard surgical maneuvers, given that hemostasis and prevention of cerebrospinal fluid leak is multifactorial. We have not encountered any complications specifically attributable to the use of fibrin glue and/or gelatin sponge for this technique. Conclusion: This technique will add to the neurosurgeons' arsenal for hemostasis and dural defect repair, in addition to the more standard and basic surgical maneuvers. Keywords: Cerebral dural venous sinus, CSF leak, Dural closure, Fibrin sealant, Gelfoam, Tisseel