Identification of Risk Factors for Postoperative Cerebrospinal Fluid Leakage and Comparison of Two Alternative Dural Augmentation Techniques in Posterior Fossa and Spinal Surgeries

Özet

AIM: To investigate comparative efficacy of a novel absorbable adhesive membrane (TissuePatchDuralTM “TPD”) and a fibrin glue(Tisseel “T”) in reducing cerebrospinal fluid (CSF) leaks after posterior fossa and spinal procedures, and also to identify potentialrisk factors for CSF leakage.MATERIAL and METHODS: This is a single-center, retrospective cohort study of 123 consecutive posterior fossa (n=77) and spinal(n=46) surgeries. Patients were grouped based on dural sealants used 2-group comparison: TPD (n=56) vs. no-TPD (n=67) and3-group comparison: T only (n=43), TPD only (n=32) vs TPD+T (n=35).RESULTS: Mean age was 38.9 ± 22.2 years (62 males, 61 females). Baseline characteristics were similar between groups. Neither2-group (TPD: 10.4% vs no-TPD: 8.9%; p=0.778) nor 3-group (T: 9.3% vs TPD: 6.3% vs TPD+T: 14.3%; p=0.539) comparisonsrevealed a significant difference in postoperative CSF leakage rates. Multivariate analysis showed that diagnosis (non-tumoral vs.tumor) (OR: 5.487; 95% CI: 1.118-26.937; p=0.036); previous surgery (OR: 9.268; 95% CI: 1.911-44.958; p=0.006), postoperativehydrocephalus (OR: 5.456; 95% CI: 1.250-23.821; p=0.024) were independent predictors of postoperative CSF leakage.CONCLUSION: TissuePatchDuralTM is a novel dural sealant patch which can be safely used to reinforce dural closure in posteriorfossa and spinal surgeries, and its efficacy is comparable to widely used fibrin glue (Tisseel). Non-tumoral pathologies, previoussurgery, and postoperative hydrocephalus appear to be independent risk factors for postoperative CSF leakage.