Application-Dependent Early-Phase Stability of Autologous Fibrin Glue in Endoscopic Transsphenoidal Surgery

In endoscopic transsphenoidal surgery (eTSS), fibrin sealants are applied in a confined and frequently inclined operative field, where early-phase material behavior may influence sealant retention and procedural controllability before complete polymerization. Autologous fibrin glue is characterized by slower polymerization kinetics, which may influence its early-phase coagulation behavior immediately after application. However, the clinical relevance of this early-phase coagulation behavior and its association with application techniques remain unclear.

We retrospectively analyzed 80 patients undergoing eTSS with skull base reconstruction (41 autologous, 39 allogeneic). In the autologous group, early-phase sealant behavior was assessed using intraoperative video analysis. Coagulation time was used as a practical video-assessable parameter of early-phase coagulation behavior rather than a direct measure of mechanical stability. The impact of application technique (spray vs. nozzle) was evaluated using multivariable linear regression. Clinical outcomes were compared between autologous and allogeneic groups.

Spray application significantly reduced coagulation time compared with nozzle application (8.0 [4.3] vs. 20 [12] seconds, P<0.001). Multivariable analysis identified spray delivery (β=-10.61, P<0.001) as an independent factor associated with shorter coagulation time. Despite these technical differences, postoperative cerebrospinal fluid leakage rates were comparable between groups (4.9% vs. 10%, P=0.426).

In eTSS, the early-phase coagulation behavior of autologous fibrin glue is strongly associated with application method. Spray delivery was associated with shorter coagulation time, suggesting that application technique may influence early-phase coagulation behavior in a confined operative field. These findings provide technical insight into fibrin glue behavior during reconstruction.