Clinical Experience with Hemopatch® as a Dural Sealant in Cranial Neurosurgery

Herein, we report our clinical experience with the novel polyethylene glycol-covered matrix dural onlay, Hemopatch® (Baxter Deutschland GmbH, Unterschleißheim, Germany) for the prevention of postoperative cerebrospinal fluid (CSF) fistulas.

Retrospectively, 22 consecutive patients (11 females, 11 males, mean age: 49.8 years, range: 15-77 years) with oncological and vascular intracranial lesions were included in this study. In all patients, the Hemopatch was applied as the dural onlay. The accuracy of the primary dural sutures was distinguished into 1) no visible gaps, 2) small gaps < 3 mm, and 3) large gaps > 3 mm. We evaluated the patient charts, surgical reports, and postoperative images. The median follow-up was three months. We recorded any wound healing disorder, such as infection or CSF fistula, and postoperative hemorrhage resulting in surgical revision.

Supratentorial, infratentorial, and transsphenoidal approaches were conducted in 17, four, and one patient, respectively. Accurate sutures without visible gaps, small gaps, and large gaps were covered with the Hemopatch in 11, eight, and three patients. One patient developed a CSF fistula (4.5%), one patient had a wound infection (4.5%), and in one patient, a remote cerebellar hemorrhage occurred (unrelated to the dural closure) (4.5%). Thus, the surgical revision rate due to wound healing disorders was 9% (2/22).

It is safe and feasible to use the Hemopatch as a dural sealant. The rate of postoperative wound healing disorders in our population was in the lower range of reported surgical revision rates after supra-/infratentorial craniotomies. However, prospective and controlled clinical trials are still warranted.