Usefulness of Sealants for Dural Closure: Evaluation in an In Vitro Model

Tristan van Doormaal, Ahmet Kinaci, Sander van Thoor, Saskia Redegeld, W. Bergmann, Albert Van Der Zwan

    Research output: Contribution to journalArticleAcademicpeer-review


    BACKGROUND: Cerebrospinal fluid (CSF) leakage occurs in 4% to 32% of cranial surgeries and is associated with significant patient burden and expense. The use of sealant as an adjunct to primary dural closure is assumed to help prevent CSF leakage.

    OBJECTIVE: To examine the utility of different sealants for dural closure using an in Vitro model.

    METHODS: We evaluated 9 commonly used dural sealants, including Tachosil (Takeda Inc, Osaka, Japan), Adherus (Hyperbranch Inc, Durham, North Carolina), Duraform (Codman, Raynham, Massachusetts), Tissudura (Baxter, Deerfield, Illinois), Hemopatch (Baxter), TissuePatchDural (Tissuemed, Leeds, United Kingdom), Tisseel (Baxter), Duragen Secure (Integra, Plainsboro, New Jersey), and Duraseal, (Integra). Sealants were tested in 2 novel in Vitro setups using fresh porcine dura: the first tested the acute burst pressure of a sealed 3-mm gap, while the second examined resistance to a pressure wave mimicking intracranial pressure for 72 h.

    RESULTS: Adherus showed the highest mean burst pressure (87 ± 47 mmHg) followed by Tachosil (71 ± 16 mmHg) and Duraseal (51 ± 42 mmHg); these were the only 3 sealants showing burst pressures above normal physiological intracranial pressure. In the 72-h setup, only Adherus and Duraseal maintained appropriate sealing for the duration of the experiment. Tachosil released from the dura after 1.4 h (95% confidence interval, -1.8-4.7).

    CONCLUSION: Given the high cost of sealants and the results of this study, we advocate a critical attitude toward sealant application as an adjunct to classic dural closure.

    Original languageEnglish
    Pages (from-to)425–432
    JournalOperative neurosurgery (Hagerstown, Md.)
    Issue number4
    Publication statusPublished - Oct 2018


    • Cerebrospinal fluid leakage
    • Dura mater
    • Dural closure


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