The use of TachoSil® as a sealant of dural sutures in brain and spinal tumor neurosurgery Alfredo Pompili MD; Fabrizio Caroli; Francesco Crispo; Laura Raus; Stefano Telera MD UOC Neurosurgery National Cancer Institute "Regina Elena", Rome Italy

Introduction Methods In spinal surgery for intradural tumors, CSF collections may complicate brain From October 2010 to January 2014, we had CSF fistula requiring and spinal intradural procedures. we used TachoSil® in 115 reoperation, in only one patient with Even the most accurate dural closure craniotomies for brain tumor and in recurrent meningioma, where may fail. These events delay patient’s 41 spinal procedures for intradural Tachosil® was used over a large patch discharge and cause even more tumors. It was applied as strips, over of Tutopatch® that had been severe complications as the standard dural suture or a dural incompletely sutured, to indefinite pseudomenigocele, wound defect previously repaired with a dural margins. dehiscence, infections, meningitis. dural substitute. In the supratentorial series without Since dural suture tighness is so Follow-up ranged between 39 and 4 Tachosil®, we reported four cases relevant, different sealant and months. The decision on the selected Results requiring a spinal drainage for CSF haemostatic product have become technique pertained to the single The use of Tachosil® was fistula, two of them ultimately were available to reinforce dural closure. surgeon, without preoperative straighforward and the patches submitted to revision surgery. Time to Either in cranial or in spinal surgery, randomization and belonged to the appeared to readily adhere to the discharge was 8 days. The difference we usually pursue a watertight own surgical experiences. In sutured dura or dural substitutes and was significative (Mann Whitney test closure of the dura, if this is not particular Tachosil® was to resist tension forces, provided that p= 0.001). In the posterior fossa possible we prefer to employ preferentially used: definite margins were available. group without Tachosil® we had four autologous materials, mainly i) to seal the frontal sinus and to In cranial surgery we had four failures failures and a permanent V-P shunt for pericranial grafts. Only when such reinforce dural closure in the mini within two weeks: one patient with a hydrocephalus was required. Median options are not available, dural supraorbital approaches; the open left fronto-parietal en plaque time time to discharge was 9 days and substitutes or eterologous dural sinus is filled with muscle and sealed meningioma, one old patient with the difference was not significant patches are considered. with TachoSil®. ii) to seal dural large recurrent frontal-temporal (Mann Whitney test p = 0.53). meningioma and two with posterior In the last years different types of reconstructions in posterior fossa fibrin glues or sealant materials have surgery; iii) having carefully sutured fossa tumor. Spinal drainage was not Conclusions been increasingly used to reinforce all the dura with 6-0 prolene, after effective in two patients ultimately TachoSil® is not a dural substitute and kind of dural sutures. Tachosil® is a unilateral mini-invasive approaches to required V-P shunt for hydrocephalus. it always requires an adequate dural ready to use sealant and haemostatic remove intradural spinal Median time of discharge after suture or at least, a dural agent already safely used in general schwannomas, meningiomas and surgery was 7 days for supratentorial reconstruction with other available surgery. It consists of an absorbable other less frequent tumors and iv) in procedures and 10 days for posterior materials. equine collagen sponge coated on complex spine surgery as fossa tumors. Alone or in combination with other one side with human and somatectomies and vertebrectomies products, it helps to prevents CSF human without allergenic to reinforce the dural closure even in leakage thus decreasing patients . Placed epidurally over a absence of an evident CSF fistulas. disconfort, hospital stay with related suture, it has strong adhesive In 54 cases (39 cranial and 15 spinal) costs and more severe complications. properties in all body fluid, creating Tachosil® was used alone over the The avoidance of trivial wound an air- and liquid-tight seal. A dural sutures; in the other cases, complications is particularly relevant in honeycomb-like matrix on the sponge especially involving recurrent lesions cancer patients who may require to be builds a fibrin clot by mimicking the or surgery required to repair known submitted to adjuvant therapies final step of natural clotting and dural fistulas, other fibrin glues or without delay. helping to seal the corresponding dural substitutes were added to Incidence of CSF leakage was 4.3 % in tissue it is applied to. Tachosil® and/or implemented also this series involving different types of by a spinal drainage. We intracranial tumors and intradural retrospectively evaluate the 78 spine tumors. supratentorial and 31 posterio fossa In our experience, it may fail if used to procedures, with other 100 seal large dural defects as it may occur supratentorial and 40 infratentorial in trauma surgery or after removal of tumor cases, operated on by the bulky meningiomas, when the same surgeons before october 2010 suturable margins are undefinite, and without Tachosil®, to evaluate their in cases with associated persistent time to discharge from the hospital intracranial hypertension due to and their complications. hydrocephalus.