Identification of risk factors for postoperative cerebrospinal fluid leakage and comparison of two alternative dural augmentation techniques in posterior fossa and spinal surgeries

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may increase the risk of meningitis, compromise wound healing and cause disturbances of CSF dynamics (1,4).These potential complications, in turn, lead to increased morbidity, prolonged hospital stay, repeated surgical interventions, higher economical costs and frustration to both patients and health professionals (5,9,10,12). █ INTRODUCTIONA chieving watertight closure of dura mater is critical in most neurosurgical procedures as cerebrospinal fluid (CSF) leakage is a common and potentially harmful complication.Failure to prevent CSF leaks after dural closure AIM: To investigate comparative efficacy of a novel absorbable adhesive membrane (TissuePatchDural TM "TPD") and a fibrin glue (Tisseel "T") in reducing cerebrospinal fluid (CSF) leaks after posterior fossa and spinal procedures, and also to identify potential risk 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) and 3-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.Neither 2-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) comparisons revealed 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), postoperative hydrocephalus (OR: 5.456; 95% CI: 1.250-23.821;p=0.024) were independent predictors of postoperative CSF leakage.CONCLUSION: TissuePatchDural TM is a novel dural sealant patch which can be safely used to reinforce dural closure in posterior fossa and spinal surgeries, and its efficacy is comparable to widely used fibrin glue (Tisseel).Non-tumoral pathologies, previous surgery, and postoperative hydrocephalus appear to be independent risk factors for postoperative CSF leakage.