Effectiveness of Dural Sealants in Prevention of CSF Leakage after Craniotomy: a Systematic Review.

World Neurosurg. 2018 Jun 30. pii: S1878-8750(18)31412-8. doi: 10.1016/j.wneu.2018.06.196. [Epub ahead of print]

Effectiveness of Dural Sealants in Prevention of CSF Leakage after Craniotomy: a Systematic Review.



Cerebrospinal fluid (CSF) leakage is one of the most challenging complications in neurosurgery.


To evaluate the efficacy of dural sealants in preventing CSF leakage after cranial surgery.


A literature search was performed in the PubMed, EMBASE and Cochrane databases. The inclusion criteria were defined to include articles describing regular cranial procedures combined with the use of any dural sealant reporting CSF leakage. The primary outcome was CSF leakage (pseudomeningocele formation or incisional CSF leakage), secondary outcomes were pseudomeningocele formation, incisional CSF leakage and surgical site infection.


Twenty articles were included. Ten of these were comparative studies (sealant versus no sealant) including 3 randomized controlled trials. In the 20 articles, a total of 3682 surgical procedures were reported. The number of CSF leakages in general did not differ between the sealant group (8.2%) and control group (8.4%), RR 0.84 (0.50-1.42), I2=56%. Exclusion of non-RCT’s did not alter the results. Meta-analyses for secondary outcomes showed no difference between number of incisional CSF leakage, RR 0.30 (0.05-1.59), I2=38% Also, no difference was found in the pseudomeningocele formation, RR 1.50 (0.43-5.17), I2=0%. Surgical site infection was less seen in the sealant group (1.0%) compared to the control group (5.6%), RR 0.25 (0.13-0.48), I2=0%.


This systematic review showed that dural sealants did not reduce the number of CSF leakage in general, the number of incisional CSF leakage alone and the number of pseudomeningocele formation alone. However, dural sealants reduced the risk of surgical site infection.


Cerebrospinal fluid leakage; Cranial surgery; Dura Mater; Dural sealant







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