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首页> 外文期刊>British journal of neurosurgery >Intraoperative sealing of dura mater defects with a novel, synthetic, self adhesive patch: Application experience in 25 patients
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Intraoperative sealing of dura mater defects with a novel, synthetic, self adhesive patch: Application experience in 25 patients

机译：术中用新型合成的自粘贴剂修复硬脑膜缺陷：25位患者的应用经验

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摘要

Background. The quest for an ideal sealant for dura mater defects persists. The clinical experience with a novel, synthetic self-adhesive patch (TissuePatchDural?, Tissuemed, Leeds, UK) and its ability to prevent postoperative cerebrospinal fluid (CSF) leakage is described in this article. Methods. A recently developed, synthetic, self adhesive patch was implanted in 25 patients who underwent intradural neurosurgical procedures. The indication for use was to adjunctively seal dura mater defects. The device is a multi-laminate consisting of thin films of a commonly used structural polymer, poly(lactide-co-glycolide) and a tissue reactive polymer providing fast and strong chemical bonding of the patch with the underlying biological surface. Intraoperative handling and efficacy, biocompatibility, and postoperative observations/follow-up were analysed. Infectious complications, surgical wound features, and postoperative MRI scans were especially reviewed. The mean follow up period was 4.4 months. Results. The device provided fast and efficacious sealing of circumscribed dura mater defects within 1 minute in 23 patients (92%). Two of 25 patients developed a postoperative CSF leakage (8%), which may be secondary to particular factors predisposing these patients to CSF leaks. Surgical handling was straightforward. No infectious complications were recorded; furthermore, wound healing was unremarkable. No clinical evidence of foreign body reactions was observed. In 18 patients, postoperative MRI scans were available which did not show irregularities in any case. Conclusions. Safe and effective sealing can be accomplished with this bioabsorbable, purely synthetic and thin dural sealant, avoiding the application of foreign biologic material. The product has been shown to be effective in achieving watertight closure of the dura mater and has prevented CSF leakage in 92% of patients treated.
机译：背景。对于硬脑膜缺陷的理想密封剂的追求一直存在。本文介绍了一种新型的合成自粘贴剂（TissuePatchDural？，Tissuemed，利兹，英国）的临床经验及其防止术后脑脊液（CSF）泄漏的能力。方法。最近开发的一种合成的自粘贴剂被植入了25位接受了硬膜内神经外科手术的患者。使用的指示是辅助密封硬脑膜缺陷。该装置是多层薄膜，由常用结构聚合物，聚丙交酯-乙交酯共聚物和组织反应性聚合物的薄膜组成，可提供贴剂与下面的生物表面的快速而牢固的化学键合。分析了术中处理和疗效，生物相容性以及术后观察/随访情况。尤其对感染并发症，手术伤口特征和术后MRI扫描进行了回顾。平均随访时间为4.4个月。结果。该设备可在23分钟内（92％）在1分钟内快速有效地封闭外接硬脑膜缺损。 25例患者中有2例发生了术后CSF渗漏（8％），这可能是由于特殊因素导致的这些患者易患CSF渗漏。手术处理很简单。没有记录到传染性并发​​症。此外，伤口愈合不显着。没有观察到异物反应的临床证据。在18例患者中，可进行术后MRI扫描，但在任何情况下均未显示异常。结论使用这种可生物吸收的，纯合成且薄的硬脑膜密封剂可以实现安全有效的密封，而无需使用外来生物材料。该产品已被证明可以有效地密封硬脑膜，并在92％的患者中预防了CSF渗漏。

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