Adherus Dural Sealant in Endoscopic Skull Base Surgery: Safety, Imaging Characteristics, and Sinonasal Quality of Life

Abstract

Objective This study was aimed to compare the safety profiles, magnetic resonance imaging (MRI) findings, and sinonasal outcome test (SNOT-22) scores of Adherus dural sealant, a novel tissue glue designed for skull base surgery.

Design Present study is a prospective case series.

Setting The research work took place at a tertiary-care academic medical center.

Participants Consecutive series of 26 patients undergoing endoscopic skull base surgery (ESBS) with Adherus was compared with a control group of 24 patients matched for tumor type and size with DuraSeal as a sealant.

Main Outcome Measures Postoperative complication rates, imaging characteristics, and postoperative SNOT-22 scores were measured and compared.

Results No postoperative cerebrospinal fluid (CSF) leaks, intracranial hemorrhages, or mucoceles were observed in either cohort. Adherus was more likely to be identifiable on immediate postoperative MRI (50 vs. 20.8%, p = 0.032). In patients in whom a nasoseptal flap was utilized, the flap was opposed to the skull base in all cases regardless of sealant selected. Postoperative SNOT-22 total (17.25 [±10.81] vs. 14.85 [±14.22], p = 0.609) and subdomain scores were similar between the two groups.

Conclusions Adherus dural sealant appears to be a safe alternative to Duraseal in ESBS with comparable quality of life outcomes and imaging findings. These preliminary results are promising but should be examined in a larger population with long-term follow-up.

Keywords

skull base repair - quality of life - imaging - dural sealant - Duraseal - Adherus - nasoseptal flap

Note

Presented at the American Academy of Otolaryngology–Head and Neck Surgery Annual Meeting, October 2018, Atlanta, Georgia, United States.

Publikationsverlauf

Eingereicht: 07. Februar 2019

Angenommen: 11. Juni 2019

Artikel online veröffentlicht:
02. August 2019

• References

• 1 Strong MJ, West GA, Woo H. et al. A pivotal randomized clinical trial evaluating the safety and effectiveness of a novel hydrogel dural sealant as an adjunct to dural repair. Oper Neurosurg (Hagerstown) 2017; 13 (02) 204-212
• 2 van Doormaal T, Kinaci A, van Thoor S, Redegeld S, Bergmann W, van der Zwan A. Usefulness of sealants for dural closure: evaluation in an in vitro model. Oper Neurosurg (Hagerstown) 2018; 15 (04) 425-432
• 3 Schwartz TH, Fraser JF, Brown S, Tabaee A, Kacker A, Anand VK. Endoscopic cranial base surgery: classification of operative approaches. Neurosurgery 2008; 62 (05) 991-1002 , discussion 1002–1005
• 4 Patel KS, Komotar RJ, Szentirmai O. et al. Case-specific protocol to reduce cerebrospinal fluid leakage after endonasal endoscopic surgery. J Neurosurg 2013; 119 (03) 661-668
• 5 Bleier BS, Wang EW, Vandergrift III WA, Schlosser RJ. Mucocele rate after endoscopic skull base reconstruction using vascularized pedicled flaps. Am J Rhinol Allergy 2011; 25 (03) 186-187
• 6 Soudry E, Psaltis AJ, Lee KH, Vaezafshar R, Nayak JV, Hwang PH. Complications associated with the pedicled nasoseptal flap for skull base reconstruction. Laryngoscope 2015; 125 (01) 80-85
• 7 Hopkins C, Gillett S, Slack R, Lund VJ, Browne JP. Psychometric validity of the 22-item sinonasal outcome test. Clin Otolaryngol 2009; 34 (05) 447-454
• 8 Balaker AE, Bergsneider M, Martin NA, Wang MB. Evolution of sinonasal symptoms following endoscopic anterior skull base surgery. Skull Base 2010; 20 (04) 245-251
• 9 McCoul ED, Bedrosian JC, Akselrod O, Anand VK, Schwartz TH. Preservation of multidimensional quality of life after endoscopic pituitary adenoma resection. J Neurosurg 2015; 123 (03) 813-820
• 10 Kacher DF, Frerichs K, Pettit J, Campbell PK, Meunch T, Norbash AM. DuraSeal magnetic resonance and computed tomography imaging: evaluation in a canine craniotomy model. Neurosurgery 2006; 58 (1, Suppl.): ONS140-ONS147, discussion ONS140–ONS147
• 11 Blackburn SL, Smyth MD. Hydrogel-induced cervicomedullary compression after posterior fossa decompression for Chiari malformation. Case report. J Neurosurg 2007; 106 (4, Suppl.): 302-304
• 12 Thavarajah D, De Lacy P, Hussain R, Redfern RM. Postoperative cervical cord compression induced by hydrogel (DuraSeal): a possible complication. Spine 2010; 35 (01) E25-E26
• 13 Eloy JA, Choudhry OJ, Friedel ME, Kuperan AB, Liu JK. Endoscopic nasoseptal flap repair of skull base defects: is addition of a dural sealant necessary?. Otolaryngol Head Neck Surg 2012; 147 (01) 161-166
• 14 McCoul ED, Anand VK, Singh A, Nyquist GG, Schaberg MR, Schwartz TH. Long-term effectiveness of a reconstructive protocol using the nasoseptal flap after endoscopic skull base surgery. World Neurosurg 2014; 81 (01) 136-143
• 15 D'Anza B, Tien D, Stokken JK, Recinos PF, Woodard TR, Sindwani R. Role of lumbar drains in contemporary endonasal skull base surgery: Meta-analysis and systematic review. Am J Rhinol Allergy 2016; 30 (06) 430-435