DuraSeal™ in Endoscopic Repair of Cerebrospinal Fluid Leak

Abstract

Objective: 1) Review use of DuraSeal (Confluent Surgical, Waltham, MA) as sealant in the primary repair of spontaneous cerebrospinal fluid (CSF) leaks and in secondary repair following transspehnoidal pituitary surgery for persistent leak. 2) Compare success and postoperative course of DuraSeal to fibrin glues in our patients and in the literature. Method: A database of endoscopic cerebrospinal fluid leak repairs was created by retrospective review of the operative log from 1999 to 2012 at a tertiary care hospital. Operative reports and postoperative hospital records were collected and analyzed for type of repair and CSF leak recurrence. Results: Nine cases were identified in which DuraSeal was used as a dural sealant during endoscopic CSF leak repair for spontaneous leak or in secondary repair of CSF leaks following previous transsphenoidal pituitary surgery. There was no recurrence of CSF leak in any patients in which DuraSeal was used in the repair. The average follow-up was 21 months (range 1 to 53 months). There were no complications from the use of DuraSeal. A similar group of 7 patients in whom fibrin glue was used noted 1 repair failure (14.3%) with a 32-month average follow-up. Conclusion: The use of DuraSeal to strengthen CSF leak repair and form a watertight seal was successful in 100% of reported cases and had no adverse events related to its use. This report of 9 patients would be the largest to date where DuraSeal was used in this manner.