Dural sealants do not reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery
Eric Wang, Michael McDowell, Paul Gardner, Carl Snyderman, Benita Valappi, Rachel Jacobs
Introduction: The application of cranial tissue sealants to assist with post-operative closure is widespread, but data are lacking regarding its utility in cases where dural closure is not performed such as endonasal surgery.
Objective: Based on a null hypothesis that the use of cranial tissue sealants after an endoscopic endonasal approach (EEA) does not prevent postoperative CSF leaks, a prospective study was conducted to assess the effect of sealant usage on postoperative CSF leak following standard reconstruction.
Methods A prospective trial of sealant usage after EEA surgery was performed from April 2017 to June 2018 at University of Pittsburgh Medical Center. The mean follow-up time for patients was 8 months. This study accrued 200 consecutive adult and pediatric patients with skull base pathology who were eligible for endoscopic endonasal resection. From April 2017 to November 2017, sealant was injected onto the surgical site after standard closure of all EEA cases. From November 2017 to June 2018, usage of sealant was stopped.
Results: Two hundred consecutive adult and pediatric patients, with a mean age of 52.7 (range 10-87 years) were enrolled in the study. The control cohort with sealant used had 5 CSF leaks (5% rate) compared to a 3 CSF leaks (3% rate) in the case group without sealant (p=0.72). No significant difference was identified in age (p=0.44) or BMI (p=0.69) between those with and without postoperative CSF leak
Conclusions: Perioperative sealant usage as a supplement for standard EEA closure techniques did not reduce the rate of postoperative CSF leaks.