[Cerebrospinal fistula tight closure of dural defects using surgical adhesives. A comparative experimental study...

In 3 cats artificial bony and dural defects of the posterior frontal sinus walls facing the frontal brain were closed with the help of a physiologic fibrin-based adhesive system (FAS) and a synthetic tissue adhesive (N-butylcyanoacrylate) in an attempt at comparing the relative merits and demerits of the 2 techniques. The bony and dural defects were partially covered with fascial tissue. Subsequently, the defects were sealed with adhesive using cyanoacrylate for the left frontal sinus and FAS for the right one. Unless healing was complicated by wound infection, fibrous tissue was found to have bridged the defects on either side 14 days after surgery, ensuring cerebrospinal fistula tight closure. Wound infection occurred in 2 cases involving the frontal sinuses closed with FAS. Micro-organisms had apparently been introduced from the respiratory tract and, in one case, spread to the contralateral frontal sinus treated with cyanoacrylate. Thus, the risk of infection associated with FAS appears to be higher than that of conventional techniques. Germ growth was found to be inhibited in vitro by adding an antibiotic to the FAS. For this reason, we would recommend the admixture of an antibiotic to the FAS whenever the adhesive is used in surgical fields which are exposed to infection. Further sutdies are needed to find the best suited antibiotic, its optimum dosage and mode of applications.